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NEWBERRY EXPRESS PHARMACY
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
NEWBERRY EXPRESS PHARMACY
Pharmacy Address
NEWBERRY EXPRESS PHARMACY, LLC
801 S BROADWAY ST
MARLOW, OK 73055-3433
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger L Neal, VP & Chief Operating Officer
(580) 251-8555
Contract Pharmacy Representative
Baker Pharmacy
Ryan Jay Ritter, Owner
(580) 298-6223
Signed By Date
7/15/2020
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