Contract Pharmacy Details

WALGREEN CO.
RRC370025-00 Saint Francis Hospital Muskogee

Covered Entity Details

Entity Name

Saint Francis Hospital Muskogee

Subdivision Name

Type

Rural Referral Center

340B ID

RRC370025-00

Entity Address

300 ROCKEFELLER DRIVE
MUSKOGEE, OK 74401

Medicare Provider Number

370025

Participating Start Date

7/1/2018

Last Recertification Date

9/12/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10223
100 NORTH 32ND STREET
MUSKOGEE, OK 74401-2101

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/11/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Eric Schick, Senior Vice President - Chief Financial Officer
(918) 494-8430

Contract Pharmacy Representative

walgreen co.
Patrick Andrews, Representative
(847) 964-8710

Signed By Date

1/15/2020

340B Drug Pricing Program Database