Covered Entity Details

DSH370004 INTEGRIS MIAMI HOSPITAL (Active) - information as of 5/13/2025 1:31:51 AM

Main Details

Name

INTEGRIS MIAMI HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH370004

Medicare Provider Number

370004

Additional Details

Current Program Status

Active

Registration Date

10/17/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/9/2022

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

200 2ND AVE. SW
MIAMI, OK 74354

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Initial start date: 1/1/2010, Termination: 2/7/2022, Reinstatement: 1/1/2023	11/03/2022

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OK	100699440A	1114931342

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	INTEGRIS PHARMACY 4188	5915 W. MEMORIAL RD, STE 110		OKLAHOMA CITY	OK	73142	10/15/2013	01/01/2014	09/30/2019	10/04/2019
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06226	2323 N MARTIN LUTHER KING AVE	OKLAHOMA CITY	OK	73111	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	OSBORN DRUGS INC	11 W CENTRAL AVE		MIAMI	OK	74354	04/09/2020	07/01/2020	08/29/2021	09/09/2021
Contract Detail	OSBORN DRUGS INC	11 W CENTRAL AVE		MIAMI	OK	74354	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/14/2020	01/01/2021	02/07/2022	02/10/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/12/2023	10/01/2023	02/15/2024	02/15/2024
Contract Detail	WAL-MART PHARMACY 10-0028	2415 N.W MAIN STREET		MIAMI	OK	74354	04/16/2014	07/01/2014	02/11/2016	02/12/2016
Contract Detail	WAL-MART PHARMACY 10-0028	2415 N.W MAIN STREET		MIAMI	OK	74354	07/12/2023	10/01/2023	02/15/2024	02/15/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/12/2023	10/01/2023	02/15/2024	02/15/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07889	910 N MAIN STREET	MIAMI	OK	74354-3317	04/14/2013	07/01/2013	02/11/2016	02/12/2016
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/14/2013	07/01/2013	07/27/2015	08/03/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/14/2013	07/01/2013	07/27/2015	08/03/2015
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/12/2023	10/01/2023	02/15/2024	02/15/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/09/2023	01/01/2024	02/15/2024	02/15/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH370004A	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS Internal Medicine Clinic	310 2ND AVE SW	MIAMI	OK	Active
DSH370004B	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS PRIMARY CARE MIAMI	310 2nd Ave SW	Miami	OK	Active
DSH370004C	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS SUNSHINE CLINIC	310 2ND AVE SW	Miami	OK	Active
DSH370004D	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS FAMILY FIRST MIAMI	310 2ND AVE SW	Miami	OK	Active
DSH370004E	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS EXPRESS CARE	21 W CENTRAL AVE	MIAMI	OK	Active
DSH370004F	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS FAMILY CARE MIAMI	310 2ND AVE SW	MIAMI	OK	Active
DSH370004G	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS MIAMI PHYSICIANS CLINIC FAMILY MEDICINE	310 2ND AVE SW	MIAMI	OK	Terminated
DSH370004H	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS PEDIATRICS MIAMI	310 2ND AVE SW	MIAMI	OK	Active
DSH370004J	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS FAMILY PRACTICE MIAMI	310 2ND AVE SW	MIAMI	OK	Active
DSH370004K	Child	DSH	INTEGRIS MIAMI HOSPITAL	INTEGRIS MIAMI HOSPITAL - INTEGRIS FAMILY MEDICINE CLINIC	310 2ND AVE SW	MIAMI	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057	Yang, Christopher K. 340B Coordinator INTEGRIS Health 4057952545	11/1/2024 3:23 PM
Details	Last Recertification Date	Update	Recertification	8/20/2023 10:00:05 PM	8/22/2024 7:17:55 AM	8/22/2024 7:17 AM
Details	Last Recertification Date	Update	Recertification		8/20/2023 10:00:05 PM	8/20/2023 10:00 PM
Contacts	Primary Contact	Update	Change Request	Wilkinson, Anja 340B Compliance Director Integris Health 9182316358	Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057	8/10/2023 11:18 AM
Contacts	Authorizing Official	Update	Profile Change Request	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4054014842	4/12/2023 1:32 PM
Contacts	Signed By	Update	Profile Change Request	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4054014842	4/12/2023 1:32 PM
Contacts	Primary Contact	Update	Profile Change Request	Wilkinson, Anja 340B Compliance Director Integris Health 4056446998	Wilkinson, Anja 340B Compliance Director Integris Health 9182316358	4/4/2023 10:16 AM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Addresses	Main Address	Update	Hospital Type Change Request	200 2ND AVE SW MIAMI, OK 74354	200 2ND AVE. SW MIAMI, OK 74354	11/9/2022 3:22 PM
Contacts	Authorizing Official	Update	Hospital Type Change Request	Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039	11/9/2022 3:22 PM
Contacts	Signed By	Insert	Hospital Type Change Request		Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039	11/9/2022 3:22 PM
Details	Last Recertification Date	Update	Hospital Type Change Request	8/23/2021 2:10:43 PM		11/9/2022 3:22 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request	1/20/2022 12:00:00 AM		11/9/2022 3:22 PM
Details	Entity Name	Update	Hospital Type Change Request	INTEGRIS Miami Hospital	INTEGRIS MIAMI HOSPITAL	11/9/2022 3:22 PM
Dates	Participating Approval Date	Update	Hospital Type Change Request	12/21/2009 12:00:00 AM	11/9/2022 3:22:32 PM	11/9/2022 3:22 PM
Details	State	Update	Hospital Type Change Request	Terminated	Approved	11/9/2022 3:22 PM
Dates	Registration Date	Update	Hospital Type Change Request	12/16/2009 12:00:00 AM	10/17/2022 5:42:33 AM	11/9/2022 3:22 PM
Dates	Signed By Date	Update	Hospital Type Change Request	11/20/2009 12:00:00 AM	11/3/2022 8:15:37 AM	11/9/2022 3:22 PM
Dates	Start Date	Update	Hospital Type Change Request	1/1/2010 12:00:00 AM	1/1/2023 12:00:00 AM	11/9/2022 3:22 PM
Terminations	Termination Date	Update	Hospital Type Change Request	2/7/2022 12:00:00 AM		11/9/2022 3:22 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request	1/20/2022 12:00:00 AM		11/9/2022 3:22 PM
Terminations	Termination Reason	Update	Hospital Type Change Request	DSH percentage below statutory minimum		11/9/2022 3:22 PM
Details	Comments Public	Insert	Hospital Type Change Request		Initial start date: 1/1/2010, Termination: 2/7/2022, Reinstatement: 1/1/2023	11/3/2022 9:17 AM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	2/10/2022 11:32 AM
Terminations	Termination Date	Update	OPA Edit Termination Info	4/1/2022 12:00:00 AM	2/7/2022 12:00:00 AM	2/10/2022 11:32 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/20/2022 12:00:00 AM	2/1/2022 10:02 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/1/2022 10:02 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	2/1/2022 10:02 AM
Terminations	Termination Effective Date	Update	Termination Request		1/20/2022 12:00:00 AM	2/1/2022 10:02 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	2/1/2022 10:02 AM
Details	Last Recertification Date	Update	Recertification	9/7/2020 10:05:39 AM	8/23/2021 2:10:43 PM	8/23/2021 2:10 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1114931342 ( )		9/7/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1114931342	9/7/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/7/2020 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 11:14:16 AM	9/7/2020 10:05:39 AM	9/7/2020 10:05 AM
Addresses	Shipping Address	Delete	Recertification	INTEGRIS Regency Pharmacy 200 Second Avenue Miami, OK 74354		9/7/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1114931342	6/30/2020 6:45 AM
Addresses	Main Address	Update	Change Request	200 Second Avenue SW MIAMI, OK 74354	200 2ND AVE SW MIAMI, OK 74354	4/9/2020 2:51 PM
Contacts	Authorizing Official	Update	Change Request	Rabel, Jonas President INTEGRIS Miami 9185407101	Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	2/3/2020 3:26 PM
Contacts	Primary Contact	Update	Profile Change Request	Wilkinson, Anja Dawn 340B Compliance Director Integris Health 4056446998	Wilkinson, Anja 340B Compliance Director Integris Health 4056446998	10/17/2019 11:56 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 10:32:45 AM	8/20/2019 11:14:16 AM	8/20/2019 11:14 AM
Contacts	Primary Contact	Update	Change Request	Raff, Charles L Pharmacy Director Integris Miami Hospital 9185407502	Wilkinson, Anja Dawn 340B Compliance Director Integris Health 4056446998	6/5/2019 7:24 AM
Contacts	Primary Contact	Update	Change Request	Bui, Kim System Manager, 340B Compliance INTEGRIS Health 4056446998	Raff, Charles L Pharmacy Director Integris Miami Hospital 9185407502	8/28/2018 7:28 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 10:29:15 AM	8/23/2018 10:32:45 AM	8/23/2018 10:32 AM
Contacts	Primary Contact	Update	Change Request	King, Eric System Manager, 340B Compliance INTEGRIS Health 4056367813	Bui, Kim System Manager, 340B Compliance INTEGRIS Health 4056446998	1/3/2018 5:03 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/20/2017 10:29:15 AM	11/20/2017 10:29 AM
Contacts	Primary Contact	Update	Change Request	Lunday, Georg F. Admin. System Director 4059493039	King, Eric System Manager, 340B Compliance INTEGRIS Health 4056367813	10/12/2017 3:29 PM
Contacts	Authorizing Official	Update	Change Request	Rabel, Jonas President 9185407101	Rabel, Jonas President INTEGRIS Miami 9185407101	10/12/2017 10:35 AM
Addresses	Main Address	Insert			200 Second Avenue SW MIAMI, OK 74354	5/5/2017 12:03 PM
Addresses	Shipping Address	Insert			INTEGRIS Regency Pharmacy 200 Second Avenue Miami, OK 74354	5/5/2017 12:03 PM
Contacts	Primary Contact	Update		Lunday, Georg F. Admin. System Director 4059493039	Lunday, Georg F. Admin. System Director 4059493039	5/5/2017 12:03 PM
Contacts	Authorizing Official	Update		Bowen, Tim President 9187873400	Rabel, Jonas President 9185407101	5/5/2017 12:03 PM
Contacts	Authorizing Official	Insert			Bowen, Tim President 9187873400	1/5/2017 11:08 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 4:01 PM
Details	Entity Name	Update		INTEGRIS BAPTIST REGIONAL HEALTH CENTER	INTEGRIS Miami Hospital	7/19/2016 10:46 AM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 4:20 PM
Details	Last Recertification Date	Update		8/20/2013 12:00:00 AM	8/21/2014 12:00:00 AM	8/21/2014 1:20 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/20/2013 12:00:00 AM	8/20/2013 2:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/10/2013 6:47 AM
Medicaid Billing	Medicaid: Number	Insert			100699440A	1/10/2013 6:47 AM
Medicaid Billing	Medicaid: State	Insert			OK	1/10/2013 6:47 AM
Contacts	Primary Contact	Insert			Lunday, Georg F. Admin. System Director 4059493039	1/10/2013 6:47 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/21/2012 7:30 AM
Details	Last Recertification Date	Insert				12/21/2009 3:01 PM
Details	Grant Number	Insert				12/21/2009 3:01 PM
Details	340B ID	Insert			DSH370004	12/21/2009 3:01 PM
Details	Is Authorizing Official EHB Data	Insert				12/21/2009 3:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/21/2009 3:01 PM
Details	Medicare Provider Number	Insert			370004	12/21/2009 3:01 PM
Details	Entity Name	Insert			INTEGRIS BAPTIST REGIONAL HEALTH CENTER	12/21/2009 3:01 PM
Details	Program Code	Insert			DSH	12/21/2009 3:01 PM
Details	Entity Subname	Insert				12/21/2009 3:01 PM
Dates	Participating Approval Date	Insert			12/21/2009 12:00:00 AM	12/21/2009 3:01 PM
Details	State	Insert			Active	12/21/2009 3:01 PM
Dates	Registration Date	Insert			12/16/2009 12:00:00 AM	12/21/2009 3:01 PM
Dates	Signed By Date	Insert			11/20/2009 12:00:00 AM	12/21/2009 3:01 PM
Dates	Start Date	Insert			1/1/2010 12:00:00 AM	12/21/2009 3:01 PM
Terminations	Termination Comments	Insert				12/21/2009 3:01 PM
Terminations	Termination Date	Insert				12/21/2009 3:01 PM
Terminations	Termination Effective Date	Insert				12/21/2009 3:01 PM
Terminations	Termination Reason	Insert				12/21/2009 3:01 PM