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WAL-MART PHARMACY 10-5315
CAH371311-00 JEFFERSON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
JEFFERSON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371311-00
Entity Address
9170 US Hwy 70
INTERSECTION HWY 70 & 81
WAURIKA, OK 73573
Medicare Provider Number
371311
Participating Start Date
1/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger L Neal, VP & Chief Operating Officer
(580) 251-8555
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2019
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