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WAL-MART PHARMACY 10-0031
CAH371337-00 EASTERN OKLAHOMA MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN OKLAHOMA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371337-00
Entity Address
105 WALL STREET
POTEAU, OK 74953
Medicare Provider Number
371337
Participating Start Date
4/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0031
Pharmacy Address
3108 N. BROADWAY
POTEAU, OK 74953
Pharmacy Comments
Contract Details
Approval Date
4/3/2017
Contract Begin Date
4/5/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Carter, CEO
(918) 635-3402
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/3/2017
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