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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02543
2345 N CLASSEN BLVD
OKLAHOMA CITY, OK 73106-5804
Pharmacy Comments
04/25/2012 address update (added N to line 1)
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
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
4/14/2021
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