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CLINIC PHARMACY
CAH371325-00 CORDELL MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CORDELL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371325-00
Entity Address
1220 N GLENN ENGISH
CORDELL, OK 73632
Medicare Provider Number
371325
Participating Start Date
10/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CLINIC PHARMACY
Pharmacy Address
CLINIC PHARMACY OF CORDELL, INC
1213 N GLENN L ENGLISH ST
CORDELL, OK 73632-2009
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Melinda K. Laird, CEO/CNO
(580) 832-3339
Contract Pharmacy Representative
Chris Johnson, Manager
(580) 832-3714
Signed By Date
1/4/2016
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