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MCCORTNEY FAMILY PHARMACY & COMPOUNDING
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
MCCORTNEY FAMILY PHARMACY & COMPOUNDING
Pharmacy Address
BRODERICK ENTERPRISES, LLC
711 E 9TH ST
ADA, OK 74820-3807
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Edward Gerten, CEO
(219) 230-3742
Contract Pharmacy Representative
Broderick Enterprises
Zack Broderick, President
(580) 332-3344
Signed By Date
10/16/2023
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