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CENTRAL DRUG
SCH370049-00 STILLWATER MEDICAL CENTER AUTHORITY
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Covered Entity Details
Entity Name
STILLWATER MEDICAL CENTER AUTHORITY
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH370049-00
Entity Address
1323 W. 6TH Ave
STILLWATER, OK 74074-4306
Medicare Provider Number
370049
Participating Start Date
7/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CENTRAL DRUG
Pharmacy Address
CDL CENTRAL DRUG, INC.
1220 W 12TH AVE
STILLWATER, OK 74074
Pharmacy Comments
Contract Details
Approval Date
1/7/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALAN LOVELACE, CHIEF FINANCIAL OFFICER
(405) 742-5729
Contract Pharmacy Representative
Chad Bayer, Owner
(405) 372-6120
Signed By Date
1/7/2015
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