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MANGUM DRUG CO
CAH371330-00 MANGUM REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MANGUM REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371330-00
Entity Address
1 WICKERSHAM DRIVE
MANGUM, OK 73554
Medicare Provider Number
371330
Participating Start Date
4/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MANGUM DRUG CO
Pharmacy Address
MANGUM DRUG CO. LLC
109 S OKLAHOMA AVE
MANGUM, OK 73554-4219
Pharmacy Comments
Contract Details
Approval Date
7/23/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Marie Harrington, CEO
(580) 782-3353 Ext: 249
Contract Pharmacy Representative
Mangum Drug Co. LLC
Katherine Murray, CEO/Owner
(580) 782-2195
Signed By Date
7/23/2020
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