340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
SCH370089-00 NORTHEASTERN HEALTH SYSTEM
Print
Covered Entity Details
Entity Name
NORTHEASTERN HEALTH SYSTEM
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370089-00
Entity Address
1400 E. DOWNING
TAHLEQUAH, OK 74464
Medicare Provider Number
370089
Participating Start Date
4/1/2018
Last Recertification Date
9/8/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16556
1611 E. 15TH ST.
TULSA, OK 74120
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/20/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
JAMES BERRY, EXEC VICE PRESIDENT
(918) 453-2263
Contract Pharmacy Representative
Northeastern Health System
Stacie Ann Larmon, Director of Pharmacy
(918) 453-2355 Ext: 4562
Signed By Date
4/14/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session