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OKLAHOMA CVS PHARMACY, L.L.C.
CHC08779-00 COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
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Covered Entity Details
Entity Name
COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
Subdivision Name
Comanche County Hospital Authority DBA Lawton Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC08779-00
Entity Address
5404 Southwest Lee Boulevard
Lawton, OK 73505
Grant Number
H80CS08779
Participating Start Date
7/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17612
2030 NW 82ND STREET
LAWTON, OK 73505
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Smith, CEO
(580) 585-5852
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2024
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