340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-3723
DSH370089 TAHLEQUAH CITY HOSPITAL
Print
Covered Entity Details
Entity Name
TAHLEQUAH CITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370089
Entity Address
1400 E DOWNING
TAHLEQUAH, OK 74464
Medicare Provider Number
370089
Participating Start Date
4/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-3723
Pharmacy Address
800 E MAIN STREET
LOCUST GROVE, OK 74352
Pharmacy Comments
Contract Details
Approval Date
3/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES BERRY, EXEC VICE PRESIDENT
(918) 453-2263
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session