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SEMINOLE DRUG
CH06393K 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- Traditions
Type
HRSA-Funded Health Center
340B ID
CH06393K
Entity Address
1131 Arlington St
Ada, OK 74820-4038
Grant Number
H80CS00757
Participating Start Date
7/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SEMINOLE DRUG
Pharmacy Address
SEMDRUG, LLC
1717 N MILT PHILLIPS AVE
SEMINOLE, OK 74868
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
Seminole Drug
Kerry Kincade, Owner, Pharmacist
(405) 382-5420
Signed By Date
10/17/2022
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