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TAHLEQUAH DRUG COMPANY
CH0612740 NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
NORTHEASTERN OKLAHOMA COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
NE OK COMMUNITY HLTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH0612740
Entity Address
124 E Main St
Hulbert, OK 74441-8902
Grant Number
H80CS00848
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
TAHLEQUAH DRUG COMPANY
Pharmacy Address
DBA: TAHLEQUAH DRUG COMPANY
2028 MAHANEY AVE
TAHLEQUAH, OK 74464
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2021
Ownership change
Contacts
Covered Entity Signing Official
Crystal Steed, Chief Operations Officer
(918) 772-3390
Contract Pharmacy Representative
Dennis Bird, Owner
(918) 431-0555
Signed By Date
4/15/2016
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