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WAL-MART PHARMACY 10-5315
DSH370178 ADAIR COUNTY HEALTH CENTER
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Covered Entity Details
Entity Name
ADAIR COUNTY HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370178
Entity Address
1401 W. Locust Street
STILWELL, OK 74960
Medicare Provider Number
370178
Participating Start Date
4/1/2015
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alan Adams, Chief Executive Officer
(918) 696-3101
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2019
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