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WAL-MART PHARMACY 10-5315
CAH371322-00 BEAVER COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BEAVER COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371322-00
Entity Address
212 East 8th Street
BEAVER, OK 73932
Medicare Provider Number
371322
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alissa Schlessman, CHIEF EXECUTIVE OFFICER
(580) 625-4551 Ext: 245
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2025
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