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DIVERSITY FAMILY PHARMACY INC
STD731091 Sounth Wind women
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Covered Entity Details
Entity Name
Sounth Wind women
Subdivision Name
Trust Women
Type
Sexually Transmitted Diseases
340B ID
STD731091
Entity Address
1240 SW 44 th street
Oklahoma city, OK 73109
Grant Number
NH25PS005143
Participating Start Date
1/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
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
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Schaunta James-Boyd, Executive Director
(405) 429-7940
Contract Pharmacy Representative
Diversity Family planning
Victor Panera, PIC
(405) 848-0026
Signed By Date
1/9/2024
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