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HOMELAND PHARMACY #182
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
HOMELAND PHARMACY #182
Pharmacy Address
1401 W BEECH AVE
DUNCAN, OK 73533-4234
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger Neal, VP-COO
(580) 606-9169
Contract Pharmacy Representative
HAC Inc.
Talitha Nichols, 340B Pharmacy Mgr
(405) 290-3423
Signed By Date
10/13/2020
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