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WAL-MART PHARMACY 10-0225
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
WAL-MART PHARMACY 10-0225
Pharmacy Address
2705 WEST BROADWAY
SULPHUR, OK 73086-6508
Pharmacy Comments
Contract Details
Approval Date
4/1/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darin Farrell, CEO
(580) 622-2161
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/1/2016
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