Contract Pharmacy Details

TRADITION DRUG
CH06393H CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.

Subdivision Name

Central Oklahoma Family Medical Center - Womens 2

Type

HRSA-Funded Health Center

340B ID

CH06393H

Entity Address

625 N Monte Vista St
Ada, OK 74820-4613

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

1/24/2022

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

CarepathRx Health System Solution
Ryan Rushing, Vice President, 340B Solutions
(512) 541-0665

Signed By Date

1/18/2022

340B Drug Pricing Program Database