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D & D PHARMACY
CH0619510 STIGLER HEALTH AND WELLNESS CENTER, INC
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Covered Entity Details
Entity Name
STIGLER HEALTH AND WELLNESS CENTER, INC
Subdivision Name
HWC - Stigler
Type
HRSA-Funded Health Center
340B ID
CH0619510
Entity Address
1505 E. MAIN STREET
STIGLER, OK 74462
Grant Number
H80CS04286
Participating Start Date
4/1/2005
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
D & D PHARMACY
Pharmacy Address
1940 N BROADWAY
P.O. BOX 592
POTEAU, OK 74953-0592
Pharmacy Comments
Contract Details
Approval Date
10/25/2012
Contract Begin Date
10/25/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2019
Ownership change
Contacts
Covered Entity Signing Official
Brooke Lattimore, Chief Operating Officer
(918) 431-2937
Contract Pharmacy Representative
Dewey Shoup, Owner/Pharm. D
(918) 647-3137
Signed By Date
9/17/2012
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