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WAL-MART PHARMACY 10-0178
CH0627800 GREAT SALT PLAINS HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GREAT SALT PLAINS HEALTH CENTER, INC.
Subdivision Name
Great Salt Plains Health Center
Type
HRSA-Funded Health Center
340B ID
CH0627800
Entity Address
405 S. Oklahoma Ave
Cherokee, OK 73728-2545
Grant Number
H80CS08744
Participating Start Date
4/1/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0178
Pharmacy Address
914 EAST OKLAHOMA BLVD.
ALVA, OK 73717
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIM STARKEY, CEO/EXECUTIVE DIRECTOR
(580) 596-2800
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/10/2017
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