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Walmart Pharmacy 10-7611
SCH370049-00 STILLWATER MEDICAL CENTER AUTHORITY
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Covered Entity Details
Entity Name
STILLWATER MEDICAL CENTER AUTHORITY
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370049-00
Entity Address
1323 W. 6TH Ave
STILLWATER, OK 74074-4306
Medicare Provider Number
370049
Participating Start Date
7/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALAN LOVELACE, CHIEF FINANCIAL OFFICER
(405) 742-5729
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/11/2023
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