Contract Pharmacy Details

LIBERTY DRUG
CH06362B Variety Care, Inc.

Covered Entity Details

Entity Name

Variety Care, Inc.

Subdivision Name

Variety Care - Ft. Cobb Health Center

Type

HRSA-Funded Health Center

340B ID

CH06362B

Entity Address

111 W. MAIN STREET
FT. COBB, OK 73038-0000

Grant Number

H80CS00543

Participating Start Date

1/1/2010

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

LIBERTY DRUG

Pharmacy Address

15 W. MAIN ST
CARNEGIE, OK 73015

Pharmacy Comments

Contract Details

Approval Date

4/16/2010

Contract Begin Date

4/16/2010

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

JOHN S. BURCHER, COO
(405) 632-6688 Ext: 233

Contract Pharmacy Representative

Liberty Drug
BRIAN HARRISON, OWNER
(580) 654-1111

Signed By Date

3/15/2010