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WOODLAKES PHARMACY
STD73109 Latino Community Development Agency
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Covered Entity Details
Entity Name
Latino Community Development Agency
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD73109
Entity Address
420 SW 10th St.
Oklahoma City, OK 73109
Grant Number
NU62PS924542
Participating Start Date
1/1/2022
Last Recertification Date
5/24/2022
Entity Termination Date
7/1/2023
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
11/3/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Yuliana Andrea Reyes, Director of Health
(405) 236-0701 Ext: 138
Contract Pharmacy Representative
Elite Analytics Group, Inc
Rex Green, CEO
(469) 899-2293
Signed By Date
10/14/2021
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