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OKLAHOMA CVS PHARMACY, L.L.C.
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
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10275
21 SOUTH STRONG BLVD.
MCALESTER, OK 74501
Pharmacy Comments
Contract Details
Approval Date
10/7/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2022
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