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OPTUM PHARMACY 702, LLC
STD73069 Community Nursing Center of Oklahoma City, LLC DBA Diversity Family Health
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Covered Entity Details
Entity Name
Community Nursing Center of Oklahoma City, LLC DBA Diversity Family Health
Subdivision Name
Norman Location
Type
Sexually Transmitted Diseases
340B ID
STD73069
Entity Address
329 White Street
Norman, OK 73069
Grant Number
NH25PS005143
Participating Start Date
7/1/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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