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PRUETT'S FOOD - PHARMACY #9
CAH371321-00 Holdenville Hospital Authority
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Covered Entity Details
Entity Name
Holdenville Hospital Authority
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371321-00
Entity Address
100 MCDOUGAL DRIVE
HOLDENVILLE, OK 74848
Medicare Provider Number
371321
Participating Start Date
8/9/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PRUETT'S FOOD - PHARMACY #9
Pharmacy Address
PRUETT'S FOOD, INC
203 E HIGHWAY ST
HOLDENVILLE, OK 74848-4075
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roberta Jeffey, CEO
(405) 379-4287
Contract Pharmacy Representative
Shannon Pruett, Pharmacy Supervisor
(580) 584-6080
Signed By Date
7/5/2017
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