340B Drug Pricing Program Database


DSH370028 INTEGRIS BAPTIST MEDICAL CENTER (Active) - information as of 5/5/2025 11:56:09 PM

Main Details
INTEGRIS BAPTIST MEDICAL CENTER
Disproportionate Share Hospital
No
DSH370028
370028


Additional Details
Active
10/10/2019
1/1/2020
11/15/2019
9/3/2024

Contacts

INTEGRIS Health
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842

INTEGRIS Health
Christopher K. Yang, 340B Coordinator
(405) 795-2545

Addresses

3300 NW EXPRESSWAY
OKLAHOMA CITY, OK 73112

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participating start date 7/1/2007; Termination date 1/1/2017; Reinstated 1/1/12020.10/22/2019
2/13/12 UPDATED MAIN ADD (WAS 3300 NW EXPRESSWAY)02/13/2012
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OK100806400C,100690810A,100699740B,100806400X,100689250A,100689250B1831103654,1831663657,1881760759,1659443372,1124346754,1790496834
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/09/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/09/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/09/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC4901 W RENO AVE STE 950
OKLAHOMA CITYOK73127-639407/14/202010/01/2020  10/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/09/202007/01/2020 07/01/202307/12/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/09/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/09/202007/01/2020  07/01/2020
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 1471 E BUSINESS CENTER DRIVE
SUITE 500 		MOUNT PROSPECTIL6005610/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SVCS 5924 NW 2ND STREET SUITE 100
OKLAHOMA CITYOK73127-651410/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 2345 WATERS DRIVE
MENDOTA HEIGHTSMN5512010/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870601/06/202304/01/2023 02/15/202402/15/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/06/202304/01/2023 02/15/202402/15/2024
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/15/202001/01/2021 02/15/202402/15/2024
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/15/202010/01/2020 02/15/202402/15/2024
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/15/202001/01/2021 10/16/202211/09/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/13/202010/01/2020 04/15/202404/15/2024
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/13/202010/01/2020 04/15/202404/15/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/13/202010/01/2020 04/15/202404/15/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/13/202010/01/2020 04/15/202404/15/2024
Contract DetailINTEGRIS PHARMACY 4173600 S MONROE ST STE 1A
ENIDOK73701-721101/21/201604/01/2016 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 4173600 S MONROE ST STE 1A
ENIDOK73701-721104/07/202107/01/2021  07/01/2021
Contract DetailINTEGRIS PHARMACY 41741205 HEALTH CENTER PKWY STE 115
YUKONOK7309901/21/201604/01/2016 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41741205 HEALTH CENTER PKWY STE 115
YUKONOK7309901/06/202304/01/2023  04/01/2023
Contract DetailINTEGRIS PHARMACY 41763300 NW EXPRESSWAY STE 1D1191
OKLAHOMA CITYOK73112-441807/16/201410/01/2014 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41763300 NW EXPRESSWAY STE 1D1191
OKLAHOMA CITYOK73112-441812/10/201901/01/2020  01/01/2020
Contract DetailINTEGRIS PHARMACY 41774401 S WESTERN AVE STE 1F181
OKLAHOMA CITYOK73109-341301/05/201604/01/2016 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41774401 S WESTERN AVE STE 1F181
OKLAHOMA CITYOK73109-341307/13/202010/01/2020  10/01/2020
Contract DetailINTEGRIS PHARMACY 41854221 S WESTERN AVE STE 1020
OKLAHOMA CITYOK73109-344808/27/201308/27/2013 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41885915 W. MEMORIAL RD, STE 110
OKLAHOMA CITYOK7314211/25/201111/25/2011 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41885915 W. MEMORIAL RD, STE 110
OKLAHOMA CITYOK7314212/10/201901/01/2020  01/01/2020
Contract DetailINTEGRIS PHARMACY 41903433 NW 56TH ST., STE 140B
OKLAHOMA CITYOK7311210/01/200810/01/2008 11/28/201612/12/2016
Contract DetailINTEGRIS PHARMACY 41903433 NW 56TH ST., STE 140B
OKLAHOMA CITYOK7311212/10/201901/01/2020  01/01/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06003 4026 N MACARTHUR BLVD
WARR ACRESOK7312204/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06004 9401 NORTH PENNSYLVANIA AVE.
THE VILLAGEOK7312004/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06009 5025 N. MAY AVE.
OKLAHOMA CITYOK7311204/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06072 10800 N ROCKWELL AVE
OKLAHOMA CITYOK7316204/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06231 4500 NW 23RD ST
OKLAHOMA CITYOK7312704/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08312 201 S. MUSTANG RD.
YUKONOK7309904/14/201307/01/2013 02/19/201612/12/2016
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06235 106 W HWY 152
MUSTANGOK7306410/15/202001/01/2021 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02271 3501 NW 36TH AVE.
NORMANOK7307204/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS/PHARMACY # 11092 15103 N MACARTHUR BLVD
OKLAHOMA CITYOK7301304/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS PHARMACY # 16736 13924 N PENNSYLVANIA AVE
OKLAHOMA CITYOK7313404/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06225 1520 S. BRYANT AVE.
EDMONDOK7301304/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06231 4500 NW 23RD ST
OKLAHOMA CITYOK7312704/15/202207/01/2022 10/03/202310/03/2023
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06020 5903 NORTHWEST EXPRESSWAY
WARR ACRESOK7313204/15/202207/01/2022 06/07/202201/13/2023
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06010 2412 N CLASSEN BLVD
OKLAHOMA CITYOK7310604/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06109 2350 N. HARPER ST., POBOX1009
CHOCTAWOK7302004/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06022 12301 N MAY AVE
OKLAHOMA CITYOK7312004/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06232 110 W VANDAMENT AVE
YUKONOK7309904/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06003 4026 N MACARTHUR BLVD
WARR ACRESOK7312204/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08314 1040 SW 19TH ST.
MOOREOK7316004/15/202207/01/2022 12/05/202201/06/2023
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06072 10800 N ROCKWELL AVE
OKLAHOMA CITYOK7316204/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06004 9401 NORTH PENNSYLVANIA AVE.
THE VILLAGEOK7312004/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06009 5025 N. MAY AVE.
OKLAHOMA CITYOK7311204/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02489 100 S. DOUGLAS BLVD.
MIDWEST CITYOK7313004/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06165 3651 W ROBINSON ST
NORMANOK7307204/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10437 304 NORTH YORK ST.
MUSKOGEEOK7440304/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05959 900 SW 44TH ST
OKLAHOMA CITYOK7310904/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08312 201 S. MUSTANG RD.
YUKONOK7309904/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06128 1016 SW LEE BLVD
LAWTONOK7350104/15/202207/01/2022 02/15/202402/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06021 800 SE 4TH ST
MOOREOK7316001/06/202304/01/2023 02/15/202402/15/2024
Contract DetailOPTUM INFUSION SERVICES 301, LP7512 NORTH BROADWAY EXT STE 308
OKLAHOMA CITYOK73116-905510/15/202001/01/2021 11/29/202311/30/2023
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850710/17/202210/17/2022  10/17/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/15/202001/01/2021  01/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265510/15/202001/01/2021  01/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/15/202001/01/2021  01/01/2021
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/15/202010/01/2020 10/01/202202/20/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/15/202001/01/2021 02/15/202402/15/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/15/202001/01/2021 02/15/202402/15/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/15/202001/01/2021 02/15/202402/15/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/15/202001/01/2021 02/15/202402/15/2024
Contract DetailSAMARITAN INFUSION SERVICES3500 N W 56TH, SUITE 201
OKLAHOMA CITYOK7311207/15/201510/01/2015 11/28/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-02211200 GARTH BROOKS BLVD
YUKONOK7309904/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-02272400 S COUNTRY CLUB ROAD
EL RENOOK7303604/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-0277501 SW 19TH STREET
MOOREOK7316004/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-03891225 W I-35 FRONTAGE RD
EDMONDOK7303404/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-0517951 EAST STATE HWY 152
MUSTANGOK7306404/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-05445401 TINKER DIAGONAL ST.
DEL CITY(MWC)OK7311504/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-05646100 WEST RENO AVENUE
OKLAHOMA CITY (W)OK7312704/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-06227800 NORTHWEST EXPRESSWAY
OKLAHOMA CITYOK7313204/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-0743100 EAST I-240 SERVICES ROAD
OKLAHOMA CITY (S)OK7314904/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-10563300 NORTH TRI-CITY DR
NEWCASTLEOK7306504/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-16262000 WEST MEMORIAL ROAD
OKLAHOMA CITYOK7313404/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-2393640 SE 4TH STREET
MOOREOK7316004/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-23941500 SW 59TH STREET
OKLAHOMA CITYOK7311904/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-28032200 WEST DANFORTH ROAD
EDMOND (NW)OK7300304/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-28041801 BELLE ISLE BLVD
OKLAHOMA CITY (C)OK7311804/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-28756437 N MACARTHUR
WARR ACRESOK7313204/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-28761301 EAST 2ND STREET
EDMONDOK7303404/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-287711101 N. ROCKWELL AVENUE
OKLAHOMA CITY (NW)OK7316204/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-2878911 S.W. 104TH STREET
OKLAHOMA CITY (SW)OK7313904/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-32751101 NW 164TH STREET
OKLAHOMA CITY (N)OK7301304/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-36152217 NORTHWEST 23RD STREET
OKLAHOMA CITY(23RD)OK7310704/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-52869320 NORTH PENN AVE
THE VILLAGEOK7312004/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-53144420 S. WESTERN AVE
OKLAHOMA CITYOK73109-341404/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART PHARMACY 10-58637520 E RENO AVE
MIDWEST CITYOK7311004/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWAL-MART STORES EAST, LPWAL-MART PHARMACY 10-3430 9011 NE 23RD ST
OKLAHOMA CITYOK7314104/16/201407/01/2014 02/19/201612/12/2016
Contract DetailWALGREEN CODBA: WALGREENS 28727 OREGON ROAD
PERRYSBURGOH4355103/04/201304/01/2013 07/10/201512/12/2016
Contract DetailWALGREEN CO  710 OVILLA ROAD
WAXAHACHIETX7516703/04/201304/01/2013 07/10/201512/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 01423 2316 N ROCKWELL AVE
BETHANYOK7300803/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 02543 2345 N CLASSEN BLVD
OKLAHOMA CITYOK73106-580403/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03642 4500 SOUTH SHIELDS BLVD
OKLAHOMA CITYOK7312903/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03643 9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITYOK7315903/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03645 101 NORTH MIDWEST BLVD.
MIDWEST CITYOK7311003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03648 301 SOUTH SANTE FE AVENUE
EDMONDOK7300303/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03668 7101 W. HEFNER RD.
OKLAHOMA CITYOK7316203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03718 6350 N. MACARTHUR
WARR ACRESOK7312203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03748 4300 SOUTHEAST 29TH ST
DEL CITYOK7311503/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03786 1201 NW 12TH STREET
MOOREOK7317003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04011 2835 SW 29TH STREET
OKLAHOMA CITYOK7311903/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04066 1099 GARTH BROOKS BLVD.
YUKONOK7309903/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04098 5120 N MAY AVENUE
OKLAHOMA CITYOK7311203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04111 12240 N. MAY AVE.
OKLAHOMA CITYOK7312003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04603 6000 S. PENNSYLVANIA
OKLAHOMA CITYOK7315903/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04673 5901 NW 39TH ST
WARR ACRESOK7312203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04784 2100 W BRITTON RD
OKLAHOMA CITYOK7312003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04895 2400 N MAY AVE
OKLAHOMA CITYOK7310703/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04896 185 E 33RD STREET
EDMONDOK7301303/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 05738 1229 N EASTERN AVE
MOOREOK7316003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 05740 7930 NW EXPRESSWAY
OKLAHOMA CITYOK7313203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 06109 1640 SW 119TH STREET
OKLAHOMA CITYOK7317003/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 06834 4400 NW 23RD STREET
OKLAHOMA CITYOK73107-264403/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 07222 112 E STATE HWY 152
MUSTANGOK73064-440203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 07444 15100 N WESTERN AVE
EDMONDOK73013-110803/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 09375 1041 S W 19TH ST
MOOREOK73160-280603/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS #10094 2675 NORTH KELLY AVENUE
EDMONDOK7300303/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS #10957 3232 TRI CITY DR.
NEWCASTLEOK7306503/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS #11095 5901 NW 122ND ST.
OKLAHOMA CITYOK7314203/04/201304/01/2013 02/11/201612/12/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 03786 1201 NW 12TH STREET
MOOREOK7317007/10/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04098 5120 N MAY AVENUE
OKLAHOMA CITYOK7311207/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03643 9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITYOK7315907/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04011 2835 SW 29TH STREET
OKLAHOMA CITYOK7311907/10/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 02543 2345 N CLASSEN BLVD
OKLAHOMA CITYOK73106-580407/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03648 301 SOUTH SANTE FE AVENUE
EDMONDOK7300307/10/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 01423 2316 N ROCKWELL AVE
BETHANYOK7300807/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04066 1099 GARTH BROOKS BLVD.
YUKONOK7309907/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04111 12240 N. MAY AVE.
OKLAHOMA CITYOK7312007/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03718 6350 N. MACARTHUR
WARR ACRESOK7312207/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03748 4300 SOUTHEAST 29TH ST
DEL CITYOK7311507/10/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03647 100 12TH AVENUE NE
NORMANOK7307107/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03668 7101 W. HEFNER RD.
OKLAHOMA CITYOK7316207/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03642 4500 SOUTH SHIELDS BLVD
OKLAHOMA CITYOK7312907/10/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 03645 101 NORTH MIDWEST BLVD.
MIDWEST CITYOK7311007/10/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #09670 1132 NORTH MAIN ST.
ALTUSOK7352107/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07222 112 E STATE HWY 152
MUSTANGOK73064-440207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09735 901 OKLAHOMA AVE
WOODWARDOK73801-465907/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05530 519 S MAIN ST
STILLWATEROK7407407/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06436 1400 EAST SECOND ST
EDMONDOK73034-532107/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #12027 1550 SW 27TH ST.
EL RENOOK73036-585207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09223 9950 SE 15TH STREET
MIDWEST CITYOK7313007/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04896 185 E 33RD STREET
EDMONDOK7301307/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #13123 116 N. GREEN AVENUE
PURCELLOK7308007/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07816 1019 E MAIN STREET
WEATHERFORDOK7309607/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04895 2400 N MAY AVE
OKLAHOMA CITYOK7310707/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04269 1427 N. HARRISON
SHAWNEEOK7480107/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07444 15100 N WESTERN AVE
EDMONDOK73013-110807/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05967 1601 S AIR DEPOT BLVD
MIDWEST CITYOK7311007/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05740 7930 NW EXPRESSWAY
OKLAHOMA CITYOK7313207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #12009 2120 S. 4TH ST.
CHICKASHAOK7301807/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06834 4400 NW 23RD STREET
OKLAHOMA CITYOK73107-264407/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09874 115 WEST THIRD ST
ELK CITYOK7364407/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16515 519 NW 23RD ST STE 109
OKLAHOMA CITYOK7310307/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04603 6000 S. PENNSYLVANIA
OKLAHOMA CITYOK7315907/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 09582 8917 NE 23RD ST
OKLAHOMA CITYOK7314107/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #10094 2675 NORTH KELLY AVENUE
EDMONDOK7300307/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04784 2100 W BRITTON RD
OKLAHOMA CITYOK7312007/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #10916 1621 S. DIVISION ST.
GUTHRIEOK7304407/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05142 2040 N HIGHWAY 81
DUNCANOK7353307/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11095 5901 NW 122ND ST.
OKLAHOMA CITYOK7314207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06109 1640 SW 119TH STREET
OKLAHOMA CITYOK7317007/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06477 615 W MAIN STREET
NORMANOK73069-706207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05738 1229 N EASTERN AVE
MOOREOK7316007/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07698 2300 N 14TH STREET
PONCA CITYOK74601-172907/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11811 600 SHAWNEE MALL DR.
SHAWNEEOK74804-132207/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04673 5901 NW 39TH ST
WARR ACRESOK7312207/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05531 929 W OWEN K. GARRIOTT RD.
ENIDOK7370107/13/202010/01/2020 04/13/202304/13/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10957 3232 TRI CITY DR.
NEWCASTLEOK7306507/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09375 1041 S W 19TH ST
MOOREOK73160-280607/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWalgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626210/14/202101/01/2022 02/15/202402/15/2024
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528403/04/201304/01/2013 07/10/201512/12/2016
Contract DetailWALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904903/04/201304/01/2013 07/10/201512/12/2016
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528407/13/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/15/202010/01/2020 10/01/202211/23/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/15/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/15/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/15/202010/01/2020 02/15/202402/15/2024
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528607/13/202010/01/2020 02/15/202402/15/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
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DSH370028AFChildDSHINTEGRIS BAPTIST MEDICAL CENTERPortland Avenue Campus - Labor & Delivery5501 N. Portland AveOKLAHOMA CITYOKTerminated
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DSH370028AWChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - CLINICAL LABORATORY5911 WEST MEMORIAL ROADOKLAHOMA CITYOKActive
DSH370028AXChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - NUCLEAR MEDICINE5911 WEST MEMORIAL ROADOKLAHOMA CITYOKActive
DSH370028AYChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - ULTRASONOGRAPHY5911 WEST MEMORIAL ROADOKLAHOMA CITYOKActive
DSH370028AZChildDSHINTEGRIS BAPTIST MEDICAL CENTERNAZIH ZUHDI TRANSPLANT INSTITUTE - KIDNEY ACQUISITION3400 NW EXPRESSWAY BUILDING COKLAHOMA CITYOKActive
DSH370028BChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA (ICIO)5911 WEST MEMORIAL ROADOKLAHOMA CITYOKActive
DSH370028BAChildDSHINTEGRIS BAPTIST MEDICAL CENTERNAZIH ZUHDI TRANSPLANT INSTITUTE - LUNG ACQUISITION3400 NW EXPRESSWAY BUILDING COKLAHOMA CITYOKActive
DSH370028BBChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - AMBULATORY INFUSION CENTER5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BCChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - BLOOD BANK/TRANSFUSION5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BDChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - ENDOSCOPY5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BEChildDSHINTEGRIS BAPTIST MEDICAL CENTERPortland Avenue Campus - Hemodialysis5501 N. Portland AveOKLAHOMA CITYOKTerminated
DSH370028BFChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - ULTRASONOGRAPHY5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BGChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - CLINICAL LABORATORY5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BHChildDSHINTEGRIS BAPTIST MEDICAL CENTERPortland Avenue Campus - Mammography5501 N. Portland AveOKLAHOMA CITYOKTerminated
DSH370028BJChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - NUCLEAR MEDICINE5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BKChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - PULMONARY MEDICINE5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BLChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - DIAGNOSTIC RADIOLOGY5501 N PORTLAND AVEOKLAHOMA CITYOKActive
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DSH370028BNChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - SURGICAL ADMISSION UNIT5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028BPChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - HEMATOLOGY/ONCOLOGY CLINIC5915 WEST MEMORIAL ROADOklahoma CityOKActive
DSH370028CChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS COMPREHENSIVE BREAST CENTER3525 NW 56TH STREETOklahoma CityOKActive
DSH370028DChildDSHINTEGRIS Baptist Medical Center INTEGRIS Cardiolgy Cath and Nuclear Lab3433 NW 56th Street, Suite 500Oklahoma CityOKTerminated
DSH370028EChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS Baptist Medical Center Surgery Center3433 Northwest 56th Street, Suite 300OKLAHOMA CITYOKTerminated
DSH370028FChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS Baptist Medical Center - Kidney Clinic3400 NW EXPRESSWAY SUITE 700OKLAHOMA CITYOKTerminated
DSH370028GChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS BAPTIST MEDICAL CENTER - SLEEP MEDICINE3300 NW 56TH STREETOklahoma CityOKActive
DSH370028HChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS Baptist Medical Center - Cardiovascular Imaging3433 NW 56TH STREET, SUITE 380OKLAHOMA CITYOKTerminated
DSH370028JChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - JIM THORPE OUTPATIENT REHABILITATION5915 WEST MEMORIAL ROADOKLAHOMA CITYOKTerminated
DSH370028LChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS BAPTIST MEDICAL CENTER - / Advanced Cardiac Care3400 NW EXPRESSWAYOKLAHOMA CITYOKTerminated
DSH370028MChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS HEART HOSPITAL - DIAGNOSTIC CARDIOLOGY3433 NW 56TH BUILDING BOKLAHOMA CITYOKActive
DSH370028NChildDSHINTEGRIS BAPTIST MEDICAL CENTERCARDIAC REHABILITATION - CARDIOPULMONARY REHAB3433 NW 56TH BUILDING BOKLAHOMA CITYOKActive
DSH370028PChildDSHINTEGRIS BAPTIST MEDICAL CENTERNAZIH ZUHDI TRANSPLANT INSTITUTE - LUNG POST TRANSPLANT3400 NW EXPRESSWAY BUILDING COKLAHOMA CITYOKActive
DSH370028QChildDSHINTEGRIS BAPTIST MEDICAL CENTERNazih Zuhdi Transplant Institute - Heart Post Transplant3400 NW Expressway Building COKLAHOMA CITYOKTerminated
DSH370028RChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS Advanced Cardiac Care - Heart Failure Center3400 NW Expressway Building COKLAHOMA CITYOKTerminated
DSH370028SChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - CARDIOPULMONARY REHAB5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028TChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS BAPTIST MEDICAL CENTER - CATH LAB/ANGIOGRAPHY3433 NW 56TH STREETOKLAHOMA CITYOKActive
DSH370028UChildDSHINTEGRIS BAPTIST MEDICAL CENTERNAZIH ZUHDI TRANSPLANT INSTITUTE - KIDNEY/PANCREAS POST TRANSPLANT3400 NW EXPRESSWAY BUILDING COKLAHOMA CITYOKActive
DSH370028VChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - MRI5501 N PORTLAND AVEOKLAHOMA CITYOKActive
DSH370028WChildDSHINTEGRIS BAPTIST MEDICAL CENTERPortland Avenue Campus - Cath lab/angiography5501 N. Portland AveOKLAHOMA CITYOKTerminated
DSH370028XChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS CANCER INSTITUTE OF OKLAHOMA - DIAGNOSTIC RADIOLOGY5911 WEST MEMORIAL ROADOKLAHOMA CITYOKActive
DSH370028YChildDSHINTEGRIS BAPTIST MEDICAL CENTERINTEGRIS BAPTIST MEDICAL CENTER - JIM THORPE OUTPATIENT REHAB5300 N INDEPENDENCE AVENUEOKLAHOMA CITYOKActive
DSH370028ZChildDSHINTEGRIS BAPTIST MEDICAL CENTERPORTLAND AVENUE CAMPUS - PACU5501 N PORTLAND AVEOKLAHOMA CITYOKActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertChange Request 17904968344/8/2025 3:23 PM
Medicaid BillingNPI: StateInsertChange Request OK4/8/2025 3:23 PM
ContactsPrimary ContactUpdateChange RequestDooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057Yang, Christopher K. 340B Coordinator INTEGRIS Health 405795254510/31/2024 3:36 PM
AddressesShipping AddressDeleteRecertificationINTEGRIS BAPTIST MEDICAL CENTER PORTLAND AVENUE 5501 NORTH PORTLAND AVENUE OKLAHOMA CITY, OK 73112 9/3/2024 2:21 PM
DetailsLast Recertification DateUpdateRecertification8/24/2023 9:16:22 AM9/3/2024 2:21:55 PM9/3/2024 2:21 PM
DetailsLast Recertification DateUpdateRecertification9/5/2022 9:36:03 AM8/24/2023 9:16:22 AM8/24/2023 9:16 AM
ContactsPrimary ContactUpdateChange RequestWilkinson, Anja 340B Compliance Director Integris Health 9182316358Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 40580260578/10/2023 11:18 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestLunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 40540148424/12/2023 1:32 PM
ContactsPrimary ContactUpdateProfile Change RequestWilkinson, Anja 340B Compliance Director Integris Health 4056446998Wilkinson, Anja 340B Compliance Director Integris Health 91823163584/4/2023 10:16 AM
ContactsAuthorizing OfficialUpdateChange RequestHubbard, Brent Chief Operating Officer INTEGRIS Health 4059493502Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 40594930399/9/2022 12:05 PM
DetailsLast Recertification DateUpdateRecertification8/23/2021 1:56:37 PM9/5/2022 9:36:03 AM9/5/2022 9:36 AM
ContactsAuthorizing OfficialUpdateChange RequestHammes, Chris Executive Vice President INTEGRIS Health System 4059493400Hubbard, Brent Chief Operating Officer INTEGRIS Health 40594935026/9/2022 8:24 AM
DetailsLast Recertification DateUpdateRecertification9/3/2020 3:32:48 PM8/23/2021 1:56:37 PM8/23/2021 1:56 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False10/15/2020 3:42 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100806400X10/15/2020 3:42 PM
Medicaid BillingMedicaid: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False10/15/2020 3:42 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100689250A10/15/2020 3:42 PM
Medicaid BillingMedicaid: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False10/15/2020 3:42 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100689250B10/15/2020 3:42 PM
Medicaid BillingMedicaid: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingNPI: NumberInsertChange Request 188176075910/15/2020 3:42 PM
Medicaid BillingNPI: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingNPI: NumberInsertChange Request 165944337210/15/2020 3:42 PM
Medicaid BillingNPI: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingNPI: NumberInsertChange Request 112434675410/15/2020 3:42 PM
Medicaid BillingNPI: StateInsertChange Request OK10/15/2020 3:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1831103654 ( ) 9/3/2020 3:32 PM
Medicaid BillingNPI: NumberDeleteRecertification1831663657 ( ) 9/3/2020 3:32 PM
Medicaid BillingNPI: NumberInsertRecertification 18311036549/3/2020 3:32 PM
Medicaid BillingNPI: StateInsertRecertification OK9/3/2020 3:32 PM
Medicaid BillingNPI: NumberInsertRecertification 18316636579/3/2020 3:32 PM
Medicaid BillingNPI: StateInsertRecertification OK9/3/2020 3:32 PM
DetailsLast Recertification DateUpdateRecertification 9/3/2020 3:32:48 PM9/3/2020 3:32 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/30/2020 9:02 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100699740B6/30/2020 9:02 AM
Medicaid BillingMedicaid: StateInsertChange Request OK6/30/2020 9:02 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/30/2020 6:45 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100690810A6/30/2020 6:45 AM
Medicaid BillingMedicaid: StateInsertChange Request OK6/30/2020 6:45 AM
Medicaid BillingNPI: NumberInsertChange Request 18311036546/30/2020 6:45 AM
Medicaid BillingNPI: NumberInsertChange Request 18316636576/30/2020 6:45 AM
AddressesMain AddressUpdateChange Request 3300 NORTHWEST EXPRESSWAY OKLAHOMA CITY, OK 73112 3300 NW EXPRESSWAY OKLAHOMA CITY, OK 731124/9/2020 3:05 PM
AddressesShipping AddressInsertChange Request INTEGRIS BAPTIST MEDICAL CENTER PORTLAND AVENUE 5501 NORTH PORTLAND AVENUE OKLAHOMA CITY, OK 731123/5/2020 1:00 PM
ContactsAuthorizing OfficialUpdateChange RequestVan Meter, Rex P. COO INTEGRIS Baptist 4057177963Hammes, Chris Executive Vice President INTEGRIS Health System 40594934002/3/2020 1:13 PM
DetailsStateUpdate ApprovedActive1/1/2020 12:04 AM
ContactsAuthorizing OfficialUpdateReinstatementJohnsen, Tim President 4059518110Van Meter, Rex P. COO INTEGRIS Baptist 405717796311/15/2019 1:56 PM
ContactsSigned ByInsertReinstatement Van Meter, Rex P. COO INTEGRIS Baptist 405717796311/15/2019 1:56 PM
ContactsPrimary ContactUpdateReinstatementLunday, Georg F. Admin. System Director INTEGRIS Health 4059493039Wilkinson, Anja 340B Compliance Director Integris Health 405644699811/15/2019 1:56 PM
DetailsLast Recertification DateUpdateReinstatement8/18/2016 12:00:00 AM 11/15/2019 1:56 PM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement11/28/2016 12:00:00 AM 11/15/2019 1:56 PM
DetailsEntity NameUpdateReinstatementINTEGRIS BAPTIST MEDICAL CENTER, INC.INTEGRIS BAPTIST MEDICAL CENTER11/15/2019 1:56 PM
DatesParticipating Approval DateUpdateReinstatement6/14/2007 12:00:00 AM11/15/2019 1:56:52 PM11/15/2019 1:56 PM
DetailsStateUpdateReinstatementTerminatedApproved11/15/2019 1:56 PM
DatesRegistration DateUpdateReinstatement6/13/2007 12:00:00 AM10/10/2019 5:11:40 PM11/15/2019 1:56 PM
DatesSigned By DateUpdateReinstatement5/30/2007 12:00:00 AM10/17/2019 4:22:03 PM11/15/2019 1:56 PM
DatesStart DateUpdateReinstatement7/1/2007 12:00:00 AM1/1/2020 12:00:00 AM11/15/2019 1:56 PM
TerminationsTermination DateUpdateReinstatement1/1/2017 12:00:00 AM 11/15/2019 1:56 PM
TerminationsTermination Effective DateUpdateReinstatement11/28/2016 12:00:00 AM 11/15/2019 1:56 PM
TerminationsTermination ReasonUpdateReinstatementDSH percentage below statutory minimum 11/15/2019 1:56 PM
DetailsComments PublicInsertReinstatement Participating start date 7/1/2007; Termination date 1/1/2017; Reinstated 1/1/12020.10/22/2019 9:32 AM
AddressesMain AddressUpdateReinstatement 3300 NW EXPRESSWAY OKLAHOMA CITY, OK 73112 3300 NORTHWEST EXPRESSWAY OKLAHOMA CITY, OK 7311210/10/2019 9:11 PM
ContactsPrimary ContactUpdate Lunday, Georg F. Admin. System Director 4059493039Lunday, Georg F. Admin. System Director INTEGRIS Health 405949303910/6/2017 4:14 PM
ContactsPrimary ContactUpdate PEARSON, RICHARD VP OPERATIONS SUPPORT 4059518204Lunday, Georg F. Admin. System Director 40594930395/5/2017 12:03 PM
AddressesMain AddressUpdate  3433 NW 56th Street OKLAHOMA CITY, OK 73112 3300 NW EXPRESSWAY OKLAHOMA CITY, OK 7311212/12/2016 1:08 PM
AddressesMain AddressInsert   3433 NW 56th Street OKLAHOMA CITY, OK 7311212/12/2016 1:08 PM
ContactsAuthorizing OfficialInsert  Johnsen, Tim President 405951811012/12/2016 1:08 PM
DatesLast Date That 340B Drugs PurchasedUpdate  11/28/2016 12:00:00 AM12/12/2016 1:07 PM
DetailsStateUpdate ActiveTerminated12/12/2016 1:07 PM
TerminationsTermination DateUpdate  1/1/2017 12:00:00 AM12/12/2016 1:07 PM
TerminationsTermination Effective DateUpdate  11/28/2016 12:00:00 AM12/12/2016 1:07 PM
TerminationsTermination ReasonUpdate  DSH percentage below statutory minimum12/12/2016 1:07 PM
DetailsLast Recertification DateUpdate 8/10/2015 12:00:00 AM8/18/2016 12:00:00 AM8/18/2016 4:21 PM
DetailsLast Recertification DateUpdate 8/7/2014 12:00:00 AM8/10/2015 12:00:00 AM8/10/2015 10:05 AM
DetailsLast Recertification DateUpdate 8/19/2013 12:00:00 AM8/7/2014 12:00:00 AM8/7/2014 2:26 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/19/2013 12:00:00 AM8/19/2013 10:11 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/9/2013 10:57 AM
Medicaid BillingMedicaid: NumberInsert  100806400C1/9/2013 10:57 AM
Medicaid BillingMedicaid: StateInsert  OK1/9/2013 10:57 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/21/2012 7:30 AM
DetailsComments PublicInsert  2/13/12 UPDATED MAIN ADD (WAS 3300 NW EXPRESSWAY)2/13/2012 12:06 PM
ContactsPrimary ContactInsert  PEARSON, RICHARD VP OPERATIONS SUPPORT 40595182046/14/2007 9:03 AM
DetailsLast Recertification DateInsert   6/14/2007 9:03 AM
DetailsGrant NumberInsert   6/14/2007 9:03 AM
Details340B IDInsert  DSH3700286/14/2007 9:03 AM
DetailsIs Authorizing Official EHB DataInsert   6/14/2007 9:03 AM
DatesLast Date That 340B Drugs PurchasedInsert   6/14/2007 9:03 AM
DetailsMedicare Provider NumberInsert  3700286/14/2007 9:03 AM
DetailsEntity NameInsert  INTEGRIS BAPTIST MEDICAL CENTER, INC.6/14/2007 9:03 AM
DetailsProgram CodeInsert  DSH6/14/2007 9:03 AM
DetailsEntity SubnameInsert   6/14/2007 9:03 AM
DatesParticipating Approval DateInsert  6/14/2007 12:00:00 AM6/14/2007 9:03 AM
DetailsStateInsert  Active6/14/2007 9:03 AM
DatesRegistration DateInsert  6/13/2007 12:00:00 AM6/14/2007 9:03 AM
DatesSigned By DateInsert  5/30/2007 12:00:00 AM6/14/2007 9:03 AM
DatesStart DateInsert  7/1/2007 12:00:00 AM6/14/2007 9:03 AM
TerminationsTermination CommentsInsert   6/14/2007 9:03 AM
TerminationsTermination DateInsert   6/14/2007 9:03 AM
TerminationsTermination Effective DateInsert   6/14/2007 9:03 AM
TerminationsTermination ReasonInsert   6/14/2007 9:03 AM