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Walgreens #21373
CH063620 Variety Care
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Covered Entity Details
Entity Name
Variety Care
Subdivision Name
Variety Care - Straka Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH063620
Entity Address
1025 Straka Ter
Oklahoma City, OK 73139-2544
Grant Number
H80CS00543
Participating Start Date
10/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walgreens #21373
Pharmacy Address
Walgreens Central Fill #21373
4100 Dale Earnhardt Way
STE 200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LOU CARMICHAEL, CEO
(405) 636-1675
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2024
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