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WAL-MART PHARMACY 10-0269
CHC08779-00 COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
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Covered Entity Details
Entity Name
COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
Subdivision Name
Comanche County Hospital Authority DBA Lawton Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC08779-00
Entity Address
5404 Southwest Lee Boulevard
Lawton, OK 73505
Grant Number
H80CS08779
Participating Start Date
7/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0269
Pharmacy Address
1002 N.W. SHERIDAN ROAD
LAWTON, OK 73505
Pharmacy Comments
Contract Details
Approval Date
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RANDALL K. SEGLER, CEO
(580) 585-5511
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/16/2014
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