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WAL-MART PHARMACY 10-0063
CH0612740 NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
NE OK COMMUNITY HLTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH0612740
Entity Address
124 E Main St
Hulbert, OK 74441-8902
Grant Number
H80CS00848
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0063
Pharmacy Address
410 S DEWEY
WAGONER, OK 74467
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Crystal Steed, Chief Operations Officer
(918) 772-3390
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/15/2022
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