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ROY'S DISCOUNT PHARMACY, LLC
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
ROY'S DISCOUNT PHARMACY, LLC
Pharmacy Address
621 HIGHWAY 2 N
WILBURTON, OK 74578-3620
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Karessa Randall, Administrator
(918) 967-4682 Ext: 9184480944
Contract Pharmacy Representative
Roy's Discount Pharmacy
Tawny Taylor, Owner
(918) 465-0111
Signed By Date
1/17/2023
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