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EQUITY PHARMACY
STD741041 Community Nursing Center of Oklahoma City DBA Diversity Family Health
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Covered Entity Details
Entity Name
Community Nursing Center of Oklahoma City DBA Diversity Family Health
Subdivision Name
Diversity Family Health-Tulsa
Type
Sexually Transmitted Diseases
340B ID
STD741041
Entity Address
1822 E15th Street
Suite A
Tulsa, OK 74104
Grant Number
NH25PS005143
Participating Start Date
1/1/2021
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
EQUITY PHARMACY
Pharmacy Address
EQUITY PHARMACY INC
1822 E 15TH ST STE C
TULSA, OK 74104
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
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
Eqity Pharmacy
Victor Panara, owner
(727) 612-4003
Signed By Date
10/10/2023
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