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TRADITION DRUG
CH06393G CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
Subdivision Name
Central Oklahoma Family Medical Center
Type
HRSA-Funded Health Center
340B ID
CH06393G
Entity Address
301 N Monte Vista St
Ada, OK 74820-4607
Grant Number
H80CS00757
Participating Start Date
4/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
TRADITION DRUG
Pharmacy Address
ADA PHARMACY, INC.
1131 ARLINGTON ST.
ADA, OK 74820
Pharmacy Comments
Contract Details
Approval Date
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/5/2022
Ownership change
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
Tradition Drug
Aaron Heilaman, Pharmacist/Owner
(580) 332-5720
Signed By Date
1/5/2022
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