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DIVERSITY FAMILY PHARMACY INC
STD73103 Community Nursing Center of Oklahoma City, LLC dba Diversity Family Health
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Covered Entity Details
Entity Name
Community Nursing Center of Oklahoma City, LLC dba Diversity Family Health
Subdivision Name
Shartel Towers Site
Type
Sexually Transmitted Diseases
340B ID
STD73103
Entity Address
1211 N Shartel
Suite 300 & 606
Oklahoma City, OK 73103
Grant Number
NH25PS005143
Participating Start Date
4/1/2020
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
DIVERSITY FAMILY PHARMACY INC
Pharmacy Address
1211 N SHARTEL AVE STE 300A
OKLAHOMA CITY, OK 73103
Pharmacy Comments
Contract Details
Approval Date
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Epic Pharmacy
Victor Panara, Pharmacist
(727) 612-4003
Signed By Date
7/10/2023
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