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Walmart Pharmacy 10-7611
CAH371342-00 McCurtain Memorial Hospital
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Covered Entity Details
Entity Name
McCurtain Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371342-00
Entity Address
1301 Lincoln Rd
Idabel, OK 74745
Medicare Provider Number
371342
Participating Start Date
7/1/2020
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kena Allen, CFO
(580) 208-3103
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/10/2023
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