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FREDERICK PHARMACY
CH063620 Variety Care
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Covered Entity Details
Entity Name
Variety Care
Subdivision Name
Variety Care - Straka Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH063620
Entity Address
1025 Straka Ter
Oklahoma City, OK 73139-2544
Grant Number
H80CS00543
Participating Start Date
10/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
FREDERICK PHARMACY
Pharmacy Address
1600 N MAIN ST
P O BOX 981
FREDERICK, OK 73542-1419
Pharmacy Comments
Contract Details
Approval Date
11/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LOU CARMICHAEL, CEO
(405) 636-1675
Contract Pharmacy Representative
SHANE VIELLY, OWNER
(580) 335-5501
Signed By Date
11/7/2014
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