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MAXOR PHARMACIES
DSH370056 COMANCHE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COMANCHE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370056
Entity Address
3401 W Gore Blvd
LAWTON, OK 73505
Medicare Provider Number
370056
Participating Start Date
10/1/2004
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
MAXOR PHARMACIES
Pharmacy Address
901 SW GOODYEAR BLVD
LAWTON, OK 73505
Pharmacy Comments
Contract Details
Approval Date
4/27/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
George Kruger, CHIEF FINANCIAL OFFICER
(580) 585-5522 Ext: 5522
Contract Pharmacy Representative
Maxor
Suzanne Hansen, Executive VP of Operations
(806) 242-7212
Signed By Date
4/27/2021
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