Contract Pharmacy Details

WAL-MART PHARMACY 10-0129
CHC33661-00 Good Shepherd Community Clinic, Inc.

Covered Entity Details

Entity Name

Good Shepherd Community Clinic, Inc.

Subdivision Name

Good Shepherd Community Clinic, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC33661-00

Entity Address

20 12th Avenue NW
Ardmore, OK 73401-5722

Grant Number

H80CS33661

Participating Start Date

1/1/2020

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0129

Pharmacy Address

1715 NORTH COMMERCE STREET
ARDMORE, OK 73401

Pharmacy Comments

Contract Details

Approval Date

9/1/2022

Contract Begin Date

9/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Teresa Mae Myers, CEO
(580) 465-3545

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

9/1/2022

340B Drug Pricing Program Database