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WAL-MART PHARMACY 10-5315
SCH370019-00 Farmers Union Hospital Association DBA Great Plains Regional Medical Center
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Covered Entity Details
Entity Name
Farmers Union Hospital Association DBA Great Plains Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370019-00
Entity Address
1801 W 3rd Street
Elk City, OK 73644
Medicare Provider Number
370019
Participating Start Date
1/1/2018
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Monica Scott, CFO
(580) 821-5500
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/5/2023
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