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WALMART PHARMACY 10-5169
CHC12883-02 South Central Medical & Resource Center
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Covered Entity Details
Entity Name
South Central Medical & Resource Center
Subdivision Name
South Central Medical Center-Maysville
Type
HRSA-Funded Health Center
340B ID
CHC12883-02
Entity Address
504 Williams
Maysville, OK 73057-3679
Grant Number
H80CS12883
Participating Start Date
4/1/2020
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana Ramming, CEO
(405) 756-1414
Contract Pharmacy Representative
South Central Medical and Resource Center
Dana Ramming, CEO
(405) 756-1414
Signed By Date
4/11/2023
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