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BROWN'S PHARMACY AND GIFTS 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
BROWN'S PHARMACY AND GIFTS LLC
Pharmacy Address
1800 ARLINGTON
ADA, OK 74820
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Karessa Randall, Administrator
(918) 967-4682 Ext: 9184480944
Contract Pharmacy Representative
Brown's Pharmacy and Gifts
Darrell Brown, Owner
(580) 279-1416
Signed By Date
4/14/2023
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