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FAMILY PHARMACY #3
CH062780A GREAT SALT PLAINS HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GREAT SALT PLAINS HEALTH CENTER, INC.
Subdivision Name
GSPHC - Medford Satellite Location
Type
HRSA-Funded Health Center
340B ID
CH062780A
Entity Address
619 N Front St
Medford, OK 73759-2704
Grant Number
H80CS08744
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY #3
Pharmacy Address
DIELRX, LLC
221 S 30TH ST
ENID, OK 73701-6455
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
TIM STARKEY, CEO/EXECUTIVE DIRECTOR
(580) 596-2800
Contract Pharmacy Representative
Family Pharmacy
Grant Diel, CEO
(580) 233-4844
Signed By Date
4/12/2023
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