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WOODLAKES PHARMACY
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
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
Elite Analytics Group, Inc
Rex Green, CEO
(469) 899-2293
Signed By Date
4/14/2021
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