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ICARE RX LLC
STD741041 Community Nursing Center of Oklahoma City DBA Diversity Family Health
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Covered Entity Details
Entity Name
Community Nursing Center of Oklahoma City DBA Diversity Family Health
Subdivision Name
Diversity Family Health-Tulsa
Type
Sexually Transmitted Diseases
340B ID
STD741041
Entity Address
1822 E15th Street
Suite A
Tulsa, OK 74104
Grant Number
NH25PS005143
Participating Start Date
1/1/2021
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
ICARE RX LLC
Pharmacy Address
14447 COUNTRY WALK DR
MIAMI, FL 33186
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
5/17/2021
Carve-In Effective Date
Contract Comments
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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