Contract Pharmacy Details

WALGREEN CO.
CAH371309-01 PAWHUSKA HOSPITAL INC.

Covered Entity Details

Entity Name

PAWHUSKA HOSPITAL INC.

Subdivision Name

PAWHUSKA FAMILY MEDICAL CLINIC - FAMILY MEDICINE

Type

Critical Access Hospital

340B ID

CAH371309-01

Entity Address

1109 E 15TH ST
Pawhuska, OK 74056

Medicare Provider Number

371309

Outpatient Facility Provider Number

378532

Participating Start Date

1/1/2022

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06618
3816 E FRANK PHILLIPS BLVD
BARTLESVILLE, OK 74006-8316

Pharmacy Comments

Contract Details

Approval Date

1/14/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jason Timothy McBride, Administrator
(918) 287-3232

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/14/2022

340B Drug Pricing Program Database