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OKLAHOMA CVS PHARMACY, L.L.C.
CHC33661-00 Good Shepherd Community Clinic, Inc.
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Covered Entity Details
Entity Name
Good Shepherd Community Clinic, Inc.
Subdivision Name
Good Shepherd Community Clinic, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC33661-00
Entity Address
20 12th Avenue NW
Ardmore, OK 73401-5722
Grant Number
H80CS33661
Participating Start Date
1/1/2020
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06222
1220 N. COMMERCE ST.
ARDMORE, OK 73401
Pharmacy Comments
Contract Details
Approval Date
9/1/2022
Contract Begin Date
9/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Teresa Mae Myers, CEO
(580) 465-3545
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
9/1/2022
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