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SOONER PHARMACY OF OKLAHOMA LLC
CAH371328-00 ARBUCKLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ARBUCKLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371328-00
Entity Address
2011 WEST BROADWAY
SULPHUR, OK 73086
Medicare Provider Number
371328
Participating Start Date
1/1/2016
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SOONER PHARMACY OF OKLAHOMA LLC
Pharmacy Address
SOONER PHARMACY OF OKLAHOMA LLC
815 W BROADWAY AVENUE
SULPHUR, OK 73086-4611
Pharmacy Comments
Contract Details
Approval Date
1/5/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/6/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Darin Farrell, CEO
(580) 622-2161
Contract Pharmacy Representative
Jeremy Hall, Manager
(580) 622-2208
Signed By Date
1/5/2016
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