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WALMART PHARMACY 10-5169
CH06393J CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
Subdivision Name
Central Oklahoma Family Medical Center - Peds II
Type
HRSA-Funded Health Center
340B ID
CH06393J
Entity Address
1214 Arlington St
Ada, OK 74820-4045
Grant Number
H80CS00757
Participating Start Date
4/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brenda Ware, CEO
(580) 925-3286 Ext: 227
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2025
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