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WOODLAKES PHARMACY
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
5/9/2024
Pharmacy Details
Pharmacy Name
WOODLAKES PHARMACY
Pharmacy Address
525 WOODLAND SQUARE BLVD STE 170
SUITE 170
CONROE, TX 77384-2212
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
5/17/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163
Signed By Date
4/14/2021
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