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GRANDVIEW PHARMACY
SCH370019-00 Farmers Union Hospital Association DBA Great Plains Regional Medical Center
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Covered Entity Details
Entity Name
Farmers Union Hospital Association DBA Great Plains Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370019-00
Entity Address
1801 W 3rd Street
Elk City, OK 73644
Medicare Provider Number
370019
Participating Start Date
1/1/2018
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
GRANDVIEW PHARMACY
Pharmacy Address
1220 W 3RD ST
PO BOX 370
ELK CITY, OK 73644
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Monica Scott, CFO
(580) 821-5500
Contract Pharmacy Representative
Grandview Pharmacy
Colby Brewster, Owner
(580) 225-5550
Signed By Date
7/14/2021
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