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WALGREEN CO.
CH06393F 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
CH06393F
Entity Address
2901 Arlington St
Ada, OK 74820-2928
Grant Number
H80CS00757
Participating Start Date
4/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04269
1427 N. HARRISON
SHAWNEE, OK 74801
Pharmacy Comments
Contract Details
Approval Date
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/5/2022
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