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EVAN'S DRUG INC.
CAH371335-00 Haskell Regional Hospital, Inc
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Covered Entity Details
Entity Name
Haskell Regional Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371335-00
Entity Address
401 NW H STREET
STIGLER, OK 74462
Medicare Provider Number
371335
Participating Start Date
4/1/2021
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
EVAN'S DRUG INC.
Pharmacy Address
P.O. BOX 309
116 W PINE ST
COLUMBUS, KS 66725-0309
Pharmacy Comments
Contract Details
Approval Date
4/20/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Andrea Karessa Randall, Administrator
(918) 967-4682 Ext: 9184480944
Contract Pharmacy Representative
Evan's Drug Inc.
JASON HULVEY, VP
(620) 429-3322
Signed By Date
4/20/2022
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