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WALMART PHARMACY 10-5169
CH0614360 FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
Subdivision Name
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
Type
HRSA-Funded Health Center
340B ID
CH0614360
Entity Address
610 E. 24TH STREET
TISHOMINGO, OK 73460
Grant Number
H80CS02454
Participating Start Date
7/1/2004
Last Recertification Date
2/18/2025
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
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TINA JAREE DAVIS, CEO
(580) 371-2343 Ext: 322
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/21/2023
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