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WAL-MART PHARMACY 10-0392
CAH371323-00 WEATHERFORD HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
WEATHERFORD HOSPITAL AUTHORITY
Subdivision Name
WEATHERFORD REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH371323-00
Entity Address
3701 E MAIN STREET
WEATHERFORD, OK 73096
Medicare Provider Number
371323
Participating Start Date
5/9/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0392
Pharmacy Address
1349 E EAGLE RD
WEATHERFORD, OK 73096
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Denton, CEO
(580) 772-5551 Ext: 750
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/14/2014
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