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IDABEL EXPRESS PHARMACY
CAH371342-00 McCurtain Memorial Hospital
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Covered Entity Details
Entity Name
McCurtain Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371342-00
Entity Address
1301 Lincoln Rd
Idabel, OK 74745
Medicare Provider Number
371342
Participating Start Date
7/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
IDABEL EXPRESS PHARMACY
Pharmacy Address
IDABEL EXPRESS PHARMACY, LLC
810 SE WASHINGTON ST
IDABEL, OK 74745-3332
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Cave, CFO
(580) 208-3104
Contract Pharmacy Representative
Baker Pharmacy
Ryan Jay Ritter, Owner
(580) 298-6223
Signed By Date
1/7/2021
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