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WALGREEN CO.
CH06393J 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 - Peds II
Type
HRSA-Funded Health Center
340B ID
CH06393J
Entity Address
1214 Arlington St
Ada, OK 74820-4045
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 #11811
600 SHAWNEE MALL DR.
SHAWNEE, OK 74804-1322
Pharmacy Comments
Contract Details
Approval Date
2/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/14/2022
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