340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH371337-00 EASTERN OKLAHOMA MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN OKLAHOMA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371337-00
Entity Address
105 WALL STREET
POTEAU, OK 74953
Medicare Provider Number
371337
Participating Start Date
4/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Griffis, 340 B Coordinator
(918) 635-3192
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
4/14/2025
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