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RX SHOPPE
CH0614360 FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
Subdivision Name
FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA
Type
HRSA-Funded Health Center
340B ID
CH0614360
Entity Address
610 E. 24TH STREET
TISHOMINGO, OK 73460
Grant Number
H80CS02454
Participating Start Date
7/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
RX SHOPPE
Pharmacy Address
872 W 13TH ST.
ATOKA, OK 74525
Pharmacy Comments
Contract Details
Approval Date
4/1/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2022
Ownership change
Contacts
Covered Entity Signing Official
TINA JAREE DAVIS, CEO
(580) 371-2343 Ext: 322
Contract Pharmacy Representative
RX Shoppe
Bob Fredrick, Pharmacist - Owner
(580) 889-3331
Signed By Date
4/1/2013
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