Covered Entity Details

STD741041 Community Nursing Center of Oklahoma City DBA Diversity Family Health (Active) - information as of 5/2/2025 10:38:16 PM

Main Details

Name

Community Nursing Center of Oklahoma City DBA Diversity Family Health

Subdivision Name

Diversity Family Health-Tulsa

Type

Sexually Transmitted Diseases

340B ID

STD741041

Grant Number

NH25PS005143

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
condoms, tests, medications
6/15/2018

Additional Details

Current Program Status

Active

Registration Date

10/12/2020

Participating Start Date

1/1/2021

Participating Approval Date

11/23/2020

Last Recertification Date

5/9/2024

Notice of Funding Opportunity (NOFO) Number

PS19-1901.NH25

Contacts

Authorizing Official

Community Nursing Center of Oklahoma City, LLCLLC
Russell Ryan Rooms, Director
(405) 848-0026

Primary Contact

Community Nursing Center of Oklahoma
Tracy Holt, Revenue Cycle Manager
(405) 848-0026 Ext: 108

Addresses

Street Address

1822 E15th Street
Suite A
Tulsa, OK 74104

Billing Address

Community Nursing Center of OKC, LLC DBA Diversity Family Health
1211 N SHARTEL AVE
300
OKLAHOMA CITY, OK 73103

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ASPCARES	AMERICAN SPECIALTY PHARMACY, INC.	3405 NW EXPRESSWAY	OKLAHOMA CITY	OK	73112	04/14/2021	07/01/2021	05/01/2023	05/02/2023
Contract Detail	ASPCARES	4309 LEMMON AVE		DALLAS	TX	75219	04/14/2021	07/01/2021	05/01/2023	05/02/2023
Contract Detail	ASPCARES	13988 DIPLOMAT DR STE 100B		FARMERS BRANCH	TX	75234-8807	04/14/2021	07/01/2021	05/01/2023	05/03/2023
Contract Detail	ASPCARES	2655 NW 20TH ST		MIAMI	FL	33142-7105	04/14/2021	07/01/2021	05/01/2023	05/03/2023
Contract Detail	AURORA PHARMACY INC	DBA PROGRESSIVE HEALTH PHARMACY	318 E COLLEGE ST STE 102	DICKSON	TN	37055	04/14/2021	07/01/2021	05/01/2023	05/03/2023
Contract Detail	CHALLENGE CARE PHARMACY	CHALLENGE CARE PHARMACY LLC	6105 BEVERLYHILL ST STE 200	HOUSTON	TX	77057	04/14/2021	07/01/2021	05/01/2023	05/02/2023
Contract Detail	COUCH PHARMACY	NRF, INC	444 S SHERIDAN RD	TULSA	OK	74112	04/14/2021	07/01/2021	05/01/2023	07/10/2023
Contract Detail	COUCH PHARMACY	NRF, INC	444 S SHERIDAN RD	TULSA	OK	74112	04/02/2024	07/01/2024		07/01/2024
Contract Detail	DIVERSITY FAMILY PHARMACY INC	1211 N SHARTEL AVE STE 300A		OKLAHOMA CITY	OK	73103	07/10/2023	10/01/2023		10/01/2023
Contract Detail	EPIC PHARMACY	EPIC PHARMACY LLC	2249 NW 39TH ST	OKLAHOMA CITY	OK	73112	04/14/2021	07/01/2021	12/29/2023	04/23/2024
Contract Detail	EQUITY PHARMACY	EQUITY PHARMACY INC	1822 E 15TH ST STE C	TULSA	OK	74104	10/10/2023	01/01/2024		01/01/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/15/2024	07/01/2024		07/01/2024
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/15/2024	07/01/2024		07/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/15/2024	07/01/2024		07/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ICARE RX LLC	14447 COUNTRY WALK DR		MIAMI	FL	33186	04/14/2021	05/17/2021		05/17/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/14/2025	04/01/2025		04/01/2025
Contract Detail	PHYSICIAN'S RX PHARMACY, LLC	PHYSICIANS RX PHARMACY, LLC	9701 APOLLO DRIVE #400	LARGO	MD	20774	04/14/2021	05/17/2021		05/17/2021
Contract Detail	PRXP OF CA LLC	PRXP OF CA LLC	4345 E LOWELL ST STE C & D	ONTARIO	CA	91761	04/14/2021	05/17/2021		05/17/2021
Contract Detail	PRXP OF NEW YORK LLC	DBA BROADWAY FAMILY PHARMACY	601 AMSTERDAM AVE	NEW YORK	NY	10024	04/14/2021	05/17/2021		05/17/2021
Contract Detail	REVAN RX	REVAN INC	5601 NW 72ND ST STE 142	WARR ACRES	OK	73132-5923	04/14/2021	07/01/2021	05/01/2023	05/02/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02543	2345 N CLASSEN BLVD	OKLAHOMA CITY	OK	73106-5804	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03038	1440 SOUTH LEWIS	TULSA	OK	74104	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04098	5120 N MAY AVENUE	OKLAHOMA CITY	OK	73112	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05739	1111 N COMMERCE STREET	ARDMORE	OK	73401	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16515	519 NW 23RD ST STE 109	OKLAHOMA CITY	OK	73103	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16556	1611 E. 15TH ST.	TULSA	OK	74120	04/14/2021	07/01/2021		07/01/2021
Contract Detail	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	10/04/2023	01/01/2024		01/01/2024
Contract Detail	WOODLAKES PHARMACY	525 WOODLAND SQUARE BLVD STE 170	SUITE 170	CONROE	TX	77384-2212	04/14/2021	05/17/2021	05/01/2023	05/02/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	5/17/2023 9:34:25 AM	5/9/2024 11:18:23 PM	5/9/2024 11:18 PM
Details	Last Recertification Date	Update	Recertification	5/23/2022 1:18:29 PM	5/17/2023 9:34:25 AM	5/17/2023 9:34 AM
Contacts	Primary Contact	Update	Change Request	Holt, Traci Billing and Compliance Diversity Family Health 4058480026	Holt, Tracy Revenue Cycle Manager Community Nursing Center of Oklahoma 4058480026-108	12/12/2022 1:33 PM
Addresses	Billing Address	Update	Recertification	Community Nursing Center of OKC, LLC DBA Diversity Family Health 1211 N SHARTEL AVE 606 OKLAHOMA CITY, OK 73103	Community Nursing Center of OKC, LLC DBA Diversity Family Health 1211 N SHARTEL AVE 300 OKLAHOMA CITY, OK 73103	5/23/2022 1:18 PM
Details	Last Recertification Date	Update	Recertification	5/4/2021 1:00:56 PM	5/23/2022 1:18:29 PM	5/23/2022 1:18 PM
Details	NOFO Number	Update	Recertification	PS18-1802	PS19-1901.NH25	5/23/2022 1:18 PM
Details	Last Recertification Date	Update	Recertification		5/4/2021 1:00:56 PM	5/4/2021 1:00 PM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Addresses	Main Address	Insert	New Registration		1822 E15th Street Suite A Tulsa, OK 74104	11/23/2020 9:53 AM
Addresses	Billing Address	Insert	New Registration		Community Nursing Center of OKC, LLC DBA Diversity Family Health 1211 N SHARTEL AVE 606 OKLAHOMA CITY, OK 73103	11/23/2020 9:53 AM
Contacts	Signed By	Insert	New Registration		Rooms, Russell Ryan Director Community Nursing Center of Oklahoma City, LLCLLC 4058480026	11/23/2020 9:53 AM
Details	340B ID	Update	New Registration		STD741041	11/23/2020 9:53 AM
Details	NOFO Number	Update	New Registration	N/A	PS18-1802	11/23/2020 9:53 AM
Dates	Participating Approval Date	Update	New Registration		11/23/2020 9:53:08 AM	11/23/2020 9:53 AM
Details	State	Update	New Registration	Pending	Approved	11/23/2020 9:53 AM
Dates	Signed By Date	Update	New Registration		11/4/2020 9:47:02 AM	11/23/2020 9:53 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	11/23/2020 9:53 AM
Addresses	Main Address	Insert	New Registration		1822 E15th Street Suite A Tulsa, OK 74104	10/12/2020 3:15 PM
Addresses	Billing Address	Insert	New Registration		Community Nursing Center of OKC, LLC DBA Diversity Family Health 1211 N SHARTEL AVE 606 OKLAHOMA CITY, OK 73103	10/12/2020 3:15 PM
Details	Nature of Support: In Kind Support Description	Insert	New Registration		condoms, tests, medications	10/12/2020 3:15 PM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	10/12/2020 3:15 PM
Details	Nature of Support: Support Received From Date	Insert	New Registration		6/15/2018 12:00:00 AM	10/12/2020 3:15 PM
Details	Nature of Support: Support Received To Date	Insert	New Registration			10/12/2020 3:15 PM
Contacts	Authorizing Official	Insert	New Registration		Rooms, Russell Ryan Director Community Nursing Center of Oklahoma City, LLCLLC 4058480026	10/12/2020 3:15 PM
Contacts	Primary Contact	Insert	New Registration		Holt, Traci Billing and Compliance Diversity Family Health 4058480026	10/12/2020 3:15 PM
Details	Assistance Received From Date	Insert	New Registration			10/12/2020 3:15 PM
Details	Assistance Received To Date	Insert	New Registration			10/12/2020 3:15 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2020 3:15 PM
Details	Grant Number	Insert	New Registration		NH25PS005143	10/12/2020 3:15 PM
Details	340B ID	Insert	New Registration			10/12/2020 3:15 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2020 3:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2020 3:15 PM
Details	Medicare Provider Number	Insert	New Registration			10/12/2020 3:15 PM
Details	Entity Name	Insert	New Registration		Community Nursing Center of Oklahoma City DBA Diversity Family Health	10/12/2020 3:15 PM
Details	NOFO Number	Insert	New Registration		N/A	10/12/2020 3:15 PM
Details	Program Code	Insert	New Registration		STD	10/12/2020 3:15 PM
Details	Entity Subname	Insert	New Registration		Diversity Family Health-Tulsa	10/12/2020 3:15 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2020 3:15 PM
Details	State	Insert	New Registration		Pending	10/12/2020 3:15 PM
Dates	Registration Date	Insert	New Registration		10/12/2020 3:15:16 PM	10/12/2020 3:15 PM
Dates	Signed By Date	Insert	New Registration			10/12/2020 3:15 PM
Dates	Start Date	Insert	New Registration			10/12/2020 3:15 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2020 3:15 PM
Terminations	Termination Date	Insert	New Registration			10/12/2020 3:15 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2020 3:15 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2020 3:15 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History