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WALGREEN CO.
STD73159 Fulcrum Clinic LLC
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Covered Entity Details
Entity Name
Fulcrum Clinic LLC
Subdivision Name
Fulcrum Health & Wellness
Type
Sexually Transmitted Diseases
340B ID
STD73159
Entity Address
1601 SW 89th St
D 100
Oklahoma City, OK 73159
Grant Number
NH25PS005143-04-02
Participating Start Date
10/1/2022
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03643
9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITY, OK 73159
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sonya Diane Fergeson, Owner/Office Manager
(405) 546-7888
Contract Pharmacy Representative
Walgreens
Thomas Lindstrom, Health Systems Manager
(713) 876-5370
Signed By Date
1/16/2024
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