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D & D PHARMACY
DSH370040 Leflore County Hospital Authority
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Covered Entity Details
Entity Name
Leflore County Hospital Authority
Subdivision Name
Eastern Oklahoma Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH370040
Entity Address
105 Wall Street
Poteau, OK 74953-1148
Medicare Provider Number
370040
Participating Start Date
7/1/2013
Last Recertification Date
8/10/2016
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
D & D PHARMACY
Pharmacy Address
1940 N BROADWAY
P.O. BOX 592
POTEAU, OK 74953-0592
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Melinda Davis, Interim CEO
(918) 635-3319
Contract Pharmacy Representative
Dewey Shoup, Owner/Pharm. D
(918) 647-3137
Signed By Date
7/12/2013
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