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WALGREENS SPECIALTY PHARMACY, LLC
CAH371309-01 PAWHUSKA HOSPITAL INC.
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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
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
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
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