Contract Pharmacy Details

LIBERTY DRUG
CH063620 Variety Care

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

LIBERTY DRUG

Pharmacy Address

15 W. MAIN ST
CARNEGIE, OK 73015

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

Liberty Drug
BRIAN HARRISON, OWNER
(580) 654-1111

Signed By Date

11/7/2014