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WALGREEN CO.
CAH371309-00 PAWHUSKA HOSPITAL INC.
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Covered Entity Details
Entity Name
PAWHUSKA HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371309-00
Entity Address
1101 E 15th St
PAWHUSKA, OK 74056
Medicare Provider Number
371309
Participating Start Date
1/1/2020
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15751
1920 SE WASHINGTON BLVD
BARTLESVILLE, OK 74006
Pharmacy Comments
Contract Details
Approval Date
7/29/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Timothy McBride, Administrator
(918) 287-3232
Contract Pharmacy Representative
Pawhuska Hospital
Alex Stearns, Pharmacist in Charge
(918) 287-3232
Signed By Date
7/29/2020
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