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WALGREEN CO.
CAH371323-00 WEATHERFORD HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
WEATHERFORD HOSPITAL AUTHORITY
Subdivision Name
WEATHERFORD REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH371323-00
Entity Address
3701 E MAIN STREET
WEATHERFORD, OK 73096
Medicare Provider Number
371323
Participating Start Date
5/9/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16515
519 NW 23RD ST STE 109
OKLAHOMA CITY, OK 73103
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Denton, CEO
(580) 772-5551 Ext: 750
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2018
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