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WAL-MART PHARMACY 10-5315
CAH371328-00 ARBUCKLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ARBUCKLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371328-00
Entity Address
2011 WEST BROADWAY
SULPHUR, OK 73086
Medicare Provider Number
371328
Participating Start Date
1/1/2016
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeremy Allen Jones, Administrator
(580) 622-2161
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/7/2019
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