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WAL-MART PHARMACY 10-0260
CAH371303-00 ROGER MILLS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ROGER MILLS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371303-00
Entity Address
501 SOUTH LL MALES AVENUE
CHEYENNE, OK 73628
Medicare Provider Number
371303
Participating Start Date
7/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0260
Pharmacy Address
1200 N. HIGHWAY 77
WAXAHACHIE, TX 75165
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Cynthia E Duncan, CEO
(580) 497-3336 Ext: 224
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2020
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