No
| CHC08779-00 | 24/7 CCMH COMMUNITY PHARMACY | COMANCHE COUNTY HOSPITAL AUTHORITY |
3401 W GORE BLVD
| LAWTON | OK | 73505 | 10/06/2023 | | |
| CHC08779-00 | ACCREDO HEALTH GROUP INC | 2040 W RIO SALADO PKWY STE 101B |
| TEMPE | AZ | 85281-2010 | 07/01/2025 | | |
| CHC08779-00 | ACCREDO HEALTH GROUP INC | 1620 CENTURY CENTER PKWY |
# 109
| MEMPHIS | TN | 38134-8849 | 07/01/2025 | | |
| CHC08779-00 | ACCREDO HEALTH GROUP, INC. | 2 BOULDEN CIR STE 1 |
| NEW CASTLE | DE | 19720-3492 | 07/01/2025 | | |
| CHC08779-00 | AHSSHC | EXPEDIEN RX PHARMACY |
5050 WESLEY RD STE 120
| APOPKA | FL | 32712 | 10/01/2017 | | |
| CHC08779-00 | AMAZON PHARMACY #001 | 4500 S PLEASANT VALLEY RD STE 201 |
| AUSTIN | TX | 78744-2911 | 07/01/2018 | | |
| CHC08779-00 | APACHE DRUG | 118 E EVANS AVE |
P.O. BOX 315
| APACHE | OK | 73006-9190 | 04/01/2020 | | |
| CHC08779-00 | AZ PHARMACY, LLC | DBA AMAZON PHARMACY #002 |
3809 E WATKINS ST
| PHOENIX | AZ | 85034 | 04/01/2019 | | |
| CHC08779-00 | COMANCHE COUNTY MEMORIAL HOSP | PHARMACY DEPARTMENT |
3401 W GORE BLVD
| LAWTON | OK | 73505 | 04/01/2021 | | 11/13/2023 |
| CHC08779-00 | CVS CAREMARK | DBA CVS/CAREMARK OR CF# 11506 |
1 GREAT VALLEY BOULEVARD
| WILKES BARRE | PA | 18706 | 10/01/2021 | | |
| CHC08779-00 | CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC | DBA CVS/CAREMARK 48067 |
1780 WALL ST
| MT PROSPECT | IL | 60056 | 10/01/2021 | | |
| CHC08779-00 | CVS/SPECIALTY OR CARELONRX SPECIALTY PHA | CAREMARK, LLC |
1001 SPINKS ROAD, STE 280
| FLOWER MOUND | TX | 75028 | 04/01/2024 | | |
| CHC08779-00 | DELIVERCARERX PHARMACY LLC | DELIVERCARERX PHARMACY LLC |
1471 E BUSINESS CENTER DR
STE 200
| MT PROSPECT | IL | 60056 | 10/01/2017 | | |
| CHC08779-00 | EASTSIDE PHARMACY | 3612 SE LEE BLVD |
| LAWTON | OK | 73501 | 04/01/2020 | | 10/04/2023 |
| CHC08779-00 | EASTSIDE PHARMACY | 3612 SE LEE BLVD |
| LAWTON | OK | 73501 | 01/01/2024 | | |
| CHC08779-00 | ELGIN PHARMACY, LLC | 12889 COMMERCE ST |
| ELGIN | OK | 73538 | 07/01/2018 | | |
| CHC08779-00 | ESI MAIL PHARMACY SERVICE | DBA EXPRESS SCRIPTS |
7909 S HARDY DR STE 106
| TEMPE | AZ | 85284-1112 | 07/01/2025 | | |
| CHC08779-00 | EXPRESS SCRIPTS | ESI MAIL PHARMACY SERVICE INC |
4600 N HANLEY RD
| SAINT LOUIS | MO | 63134 | 07/01/2025 | | |
| CHC08779-00 | EXPRESS SCRIPTS PHARMACY, INC. | DBA EXPRESS SCRIPTS |
4750 E. 450 S.
| WHITESTOWN | IN | 46075 | 07/01/2025 | | |
| CHC08779-00 | EXPRESS SCRIPTS PHARMACY, INC. | DBA EXPRESS SCRIPTS |
2040 ROUTE 130 NORTH
| BURLINGTON | NJ | 08016 | 07/01/2025 | | |
| CHC08779-00 | GREAT PLAINS PHARMACY | GREAT PLAINS PHARMACY |
3201 W GORE BLVD STE A
| LAWTON | OK | 73505 | 10/01/2014 | | |
| CHC08779-00 | KEN'S RX | 802 W GORE BLVD |
| LAWTON | OK | 73501-3719 | 04/01/2020 | | 10/04/2023 |
| CHC08779-00 | LAWTON HERITAGE COMPOUNDING PHARMACY | 12 NW SHERIDAN RD |
| LAWTON | OK | 73505 | 04/01/2020 | | 04/30/2022 |
| CHC08779-00 | M.N. PHARMACY LLC | DBA AMAZON PHARMACY #003 |
6701 NW 7TH ST., STE. #199
| MIAMI | FL | 33126 | 07/01/2018 | | |
| CHC08779-00 | MAXOR PHARMACIES | 901 SW GOODYEAR BLVD |
| LAWTON | OK | 73505 | 07/01/2024 | | |
| CHC08779-00 | OKLAHOMA CVS PHARMACY, L.L.C. | DBA CVS/PHARMACY # 10520 |
2107 NW CACHE ROAD
| LAWTON | OK | 73505 | 01/01/2020 | | |
| CHC08779-00 | OKLAHOMA CVS PHARMACY, L.L.C. | DBA: CVS/PHARMACY # 06128 |
1016 SW LEE BLVD
| LAWTON | OK | 73501 | 01/01/2020 | | |
| CHC08779-00 | OKLAHOMA CVS PHARMACY, L.L.C. | DBA CVS/PHARMACY # 10274 |
1520 WEST ELK AVE.
| DUNCAN | OK | 73533 | 04/01/2024 | | |
| CHC08779-00 | OKLAHOMA CVS PHARMACY, L.L.C. | CVS PHARMACY # 17612 |
2030 NW 82ND STREET
| LAWTON | OK | 73505 | 04/01/2024 | | |
| CHC08779-00 | OPTUM PHARMACY 701, LLC | 1830 S HORNE |
| MESA | AZ | 85204 | 10/01/2024 | | |
| CHC08779-00 | OPTUM PHARMACY 704, INC. | 5627 UNIVERSITY HTS STE 108 |
| SAN ANTONIO | TX | 78249 | 10/01/2024 | | |
| CHC08779-00 | OPTUMRX | OPTUMRX INC |
6800 W 115TH ST STE 600
| OVERLAND PARK | KS | 66211-9838 | 10/01/2024 | | |
| CHC08779-00 | PILLPACK LLC | DBA PILLPACK BY AMAZON PHARMACY |
250 COMMERCIAL ST STE 2012
| MANCHESTER | NH | 03101 | 07/01/2018 | | |
| CHC08779-00 | SHERIDAN EXPRESS PHARMACY | 205 SW SHERIDAN RD |
| LAWTON | OK | 73505 | 04/01/2020 | | |
| CHC08779-00 | WAL-MART CENTRAL FILL 10-2670 | 608 SPRING HILL DR # 3 SUITE 300 |
| SPRING | TX | 77386 | 10/01/2018 | | |
| CHC08779-00 | WAL-MART PHARMACY 10-0269 | 1002 N.W. SHERIDAN ROAD |
| LAWTON | OK | 73505 | 10/01/2014 | | |
| CHC08779-00 | WAL-MART PHARMACY 10-5071 | 6301 NW QUANNAH PARKER TRWAY |
| LAWTON | OK | 73505 | 10/01/2014 | | |
| CHC08779-00 | WAL-MART PHARMACY 10-5997 | 9600 PARKSOUTH CT. SUITE 100 |
| ORLANDO | FL | 32837 | 10/01/2018 | | |
| CHC08779-00 | WALGREEN CO. | DBA: WALGREENS # 04703 |
701 NW SHERIDAN
| LAWTON | OK | 73505 | 10/01/2014 | | |
| CHC08779-00 | WALGREEN CO. | DBA: WALGREENS # 06199 |
6701 NW CACHE ROAD
| LAWTON | OK | 73505 | 10/01/2014 | | |
| CHC08779-00 | WALGREEN CO. | DBA: WALGREENS #12833 |
1107 SW LEE BLVD.
| LAWTON | OK | 73501-5605 | 10/01/2014 | | 08/11/2016 |
| CHC08779-00 | Walgreens #21373 | Walgreens Central Fill #21373 |
4100 Dale Earnhardt Way
STE 200
| Northlake | TX | 76262 | 07/01/2024 | | |
| CHC08779-00 | WALGREENS MAIL SERVICE, INC. | |
8337 S PARK CIRCLE
| ORLANDO | FL | 32819-9049 | 10/01/2014 | | 06/24/2015 |
| CHC08779-00 | WALGREENS MAIL SERVICE, INC. | 8350 S RIVER PARKWAY |
| TEMPE | AZ | 85284 | 10/01/2014 | | 06/24/2015 |
| CHC08779-00 | WALGREENS SPECIALTY PHARMACY, LLC | DBA WALGREENS SPECIALTY PHARMACY #15443 |
10530 JOHN W ELLIOTT DR STE 100
| FRISCO | TX | 75033 | 01/01/2022 | | |
| CHC08779-00 | WALMART PHARMACY 10-5169 | 2252 NORTH 8TH STREET |
SUITE A
| ROGERS | AR | 72756 | 01/01/2024 | | |
| CHC08779-00 | Walmart Pharmacy 10-7611 | 2501 Perry Rd |
| Plainfield | IN | 46168 | 01/01/2024 | | |
| Details | Last Recertification Date | Update | Recertification | | 2/10/2025 10:56:04 PM | 2/10/2025 10:56 PM |
| Details | State | Update | | Approved | Active | 4/1/2024 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | McAvoy, Sean
Executive Director
Lawton community health center
5802804413 | 3/4/2024 6:41 AM |
| Details | 340B ID | Update | New Registration | | CHC08779-21 | 3/4/2024 6:41 AM |
| Dates | Participating Approval Date | Update | New Registration | | 3/4/2024 6:41:01 AM | 3/4/2024 6:41 AM |
| Details | State | Update | New Registration | Pending | Approved | 3/4/2024 6:41 AM |
| Dates | Signed By Date | Update | New Registration | | 2/28/2024 4:26:03 PM | 3/4/2024 6:41 AM |
| Dates | Start Date | Update | New Registration | | 4/1/2024 12:00:00 AM | 3/4/2024 6:41 AM |
| Addresses | Main Address | Insert | New Registration | |
512 SW Lee Blvd
Lawton, OK 73501-5711 | 2/28/2024 4:26 PM |
| Contacts | Authorizing Official | Insert | New Registration | | McAvoy, Sean
Executive Director
Lawton community health center
5802804413 | 2/28/2024 4:26 PM |
| Contacts | Primary Contact | Insert | New Registration | | Smith, Brent
CEO
Lawton Community Health Center
5805855852 | 2/28/2024 4:26 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Grant Number | Insert | New Registration | | H80CS08779 | 2/28/2024 4:26 PM |
| Details | 340B ID | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Entity Name | Insert | New Registration | | COMANCHE COUNTY HOSPITAL AUTHORITY (TRUS | 2/28/2024 4:26 PM |
| Details | NOFO Number | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | Program Code | Insert | New Registration | | CH | 2/28/2024 4:26 PM |
| Details | Entity Subname | Insert | New Registration | | LCHC Southcare Clinic | 2/28/2024 4:26 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Details | State | Insert | New Registration | | Pending | 2/28/2024 4:26 PM |
| Dates | Registration Date | Insert | New Registration | | 2/28/2024 4:26:00 PM | 2/28/2024 4:26 PM |
| Dates | Signed By Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Dates | Start Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Terminations | Termination Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 2/28/2024 4:26 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 2/28/2024 4:26 PM |