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WALGREEN CO.
STD73103 Community Nursing Center of Oklahoma City, LLC dba Diversity Family Health
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Covered Entity Details
Entity Name
Community Nursing Center of Oklahoma City, LLC dba Diversity Family Health
Subdivision Name
Shartel Towers Site
Type
Sexually Transmitted Diseases
340B ID
STD73103
Entity Address
1211 N Shartel
Suite 300 & 606
Oklahoma City, OK 73103
Grant Number
NH25PS005143
Participating Start Date
4/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03038
1440 SOUTH LEWIS
TULSA, OK 74104
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2020
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