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Walgreens MFC #21373
STD73069 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
Norman Location
Type
Sexually Transmitted Diseases
340B ID
STD73069
Entity Address
329 White Street
Norman, OK 73069
Grant Number
NH25PS005143
Participating Start Date
7/1/2023
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Walgreens
John Ray Las Dulce, Analyst, 340B Implementation
(224) 542-5563
Signed By Date
10/4/2023
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