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WAL-MART PHARMACY 10-1626
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
WAL-MART PHARMACY 10-1626
Pharmacy Address
2000 WEST MEMORIAL ROAD
OKLAHOMA CITY, OK 73134
Pharmacy Comments
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LOU CARMICHAEL, CEO
(405) 636-1675
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/4/2019
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