Covered Entity Details

DSH370106G INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION (Active) - information as of 6/2/2025 8:30:42 AM

Main Details

Name

INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

Subdivision Name

INTEGRIS SOUTHWEST MEDICAL CENTER - CARDIAC REHABILITATION AND CARDIOPULMONARY REHAB

Type

Disproportionate Share Hospital

Rural

340B ID

DSH370106G

Medicare Provider Number

370106

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2019

Participating Start Date

10/1/2019

Participating Approval Date

9/5/2019

Last Recertification Date

9/3/2024

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

4200 S DOUGLAS AVE
SUITE 114
Oklahoma City, OK 73109

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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	100700200A,100700200R	1457372625,1336252717

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH370106A	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - CANCER CENTER	4301 S WESTERN AVE	Oklahoma City	OK	Active
DSH370106B	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - HYPERBARIC MEDICINE AND WOUND CARE CENTER	4221 S WESTERN	Oklahoma City	OK	Active
DSH370106C	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - JIM THORPE OUTPATIENT REHABILITATION	4100 S DOUGLAS AVE	Oklahoma City	OK	Terminated
DSH370106D	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - BREAST HEALTH AND IMAGING CENTER	4221 S WESTERN AVE	OKLAHOMA CITY	OK	Active
DSH370106E	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS Southwest Medical Center / Rehab Unit	3300 NW Expressway	Oklahoma City	OK	Terminated
DSH370106F	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - ANTICOAGULATION CLINIC	4221 S WESTERN AVE	OKLAHOMA CITY	OK	Active
DSH370106G	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - CARDIAC REHABILITATION AND CARDIOPULMONARY REHAB	4200 S DOUGLAS AVE	Oklahoma City	OK	Active
DSH370106H	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - INTEGRIS JIM THORPE REHABILITATION - AQUATICS	4301 S WESTERN AVE	OKLAHOMA CITY	OK	Terminated
DSH370106J	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - IHH DIAGNOSTIC CARDIOLOGY - DIAGNOSTIC CARDIOLOGY	4301 S WESTERN AVE	OKLAHOMA CITY	OK	Active
DSH370106K	Child	DSH	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	INTEGRIS SOUTHWEST MEDICAL CENTER - PREADMISSION TESTING	4301 S WESTERN AVE	OKLAHOMA CITY	OK	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057	Yang, Christopher K. 340B Coordinator INTEGRIS Health 4057952545	11/4/2024 7:46 AM
Addresses	Main Address	Update	Recertification	4200 S Douglas Ave Ste 114 Oklahoma City, OK 73109	4200 S DOUGLAS AVE SUITE 114 Oklahoma City, OK 73109	9/3/2024 2:12 PM
Details	Last Recertification Date	Update	Recertification	8/23/2023 2:55:04 PM	9/3/2024 2:12:42 PM	9/3/2024 2:12 PM
Details	Entity Subname	Update	Recertification	SMC Cardiac Rehabilitation - Cardiopulmonary Rehab	INTEGRIS SOUTHWEST MEDICAL CENTER - CARDIAC REHABILITATION AND CARDIOPULMONARY REHAB	9/3/2024 2:12 PM
Contacts	Primary Contact	Update	Group Change Request	Wilkinson, Anja 340B Compliance Director Integris Health 9182316358	Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057	9/11/2023 8:16 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 11:08:47 PM	8/23/2023 2:55:04 PM	8/23/2023 2:55 PM
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	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
Contacts	Authorizing Official	Update	Change Request	Hubbard, Brent Chief Operating Officer INTEGRIS Health 4059493502	Lunday, Georg F. Chief Pharmacy Officer INTEGRIS Health 4059493039	11/29/2022 8:07 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:16:12 PM	8/30/2022 11:08:47 PM	8/30/2022 11:08 PM
Contacts	Authorizing Official	Update	Change Request	Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	Hubbard, Brent Chief Operating Officer INTEGRIS Health 4059493502	6/7/2022 10:14 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 3:50:10 PM	8/23/2021 2:16:12 PM	8/23/2021 2:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2020 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100700200R	9/3/2020 3:50 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OK	9/3/2020 3:50 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1457372625	9/3/2020 3:50 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/3/2020 3:50 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336252717	9/3/2020 3:50 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/3/2020 3:50 PM
Details	Last Recertification Date	Update	Recertification		9/3/2020 3:50:10 PM	9/3/2020 3:50 PM
Contacts	Authorizing Official	Update	Change Request	Cash, Jordan President INTEGRIS South Oklahoma City Hospital Corporation 4056367284	Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	2/3/2020 3:29 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	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Cash, Jordan President INTEGRIS South Oklahoma City Hospital Corporation 4056367284	9/5/2019 10:36 AM
Details	340B ID	Update	New Registration		DSH370106G	9/5/2019 10:36 AM
Details	Entity Name	Update	New Registration	INTEGRIS SOUTHWEST MEDICAL CENTER	INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION	9/5/2019 10:36 AM
Details	Entity Subname	Update	New Registration	SMC Cardiac Rehabilitation	SMC Cardiac Rehabilitation - Cardiopulmonary Rehab	9/5/2019 10:36 AM
Dates	Participating Approval Date	Update	New Registration		9/5/2019 10:36:06 AM	9/5/2019 10:36 AM
Details	State	Update	New Registration	Pending	Approved	9/5/2019 10:36 AM
Dates	Signed By Date	Update	New Registration		7/15/2019 3:41:31 PM	9/5/2019 10:36 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	9/5/2019 10:36 AM
Addresses	Main Address	Insert	New Registration		4200 S Douglas Ave Ste 114 Oklahoma City, OK 73109	7/15/2019 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/15/2019 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100700200A	7/15/2019 10:43 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	7/15/2019 10:43 AM
Contacts	Authorizing Official	Insert	New Registration		Cash, Jordan President INTEGRIS South Oklahoma City Hospital Corporation 4056367284	7/15/2019 10:43 AM
Contacts	Primary Contact	Insert	New Registration		Wilkinson, Anja Dawn 340B Compliance Director Integris Health 4056446998	7/15/2019 10:43 AM
Details	Last Recertification Date	Insert	New Registration			7/15/2019 10:43 AM
Details	Grant Number	Insert	New Registration			7/15/2019 10:43 AM
Details	340B ID	Insert	New Registration			7/15/2019 10:43 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2019 10:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2019 10:43 AM
Details	Medicare Provider Number	Insert	New Registration		370106	7/15/2019 10:43 AM
Details	Entity Name	Insert	New Registration		INTEGRIS SOUTHWEST MEDICAL CENTER	7/15/2019 10:43 AM
Details	Program Code	Insert	New Registration		DSH	7/15/2019 10:43 AM
Details	Entity Subname	Insert	New Registration		SMC Cardiac Rehabilitation	7/15/2019 10:43 AM
Dates	Participating Approval Date	Insert	New Registration			7/15/2019 10:43 AM
Details	State	Insert	New Registration		Pending	7/15/2019 10:43 AM
Dates	Registration Date	Insert	New Registration		7/15/2019 10:43:46 AM	7/15/2019 10:43 AM
Dates	Signed By Date	Insert	New Registration			7/15/2019 10:43 AM
Dates	Start Date	Insert	New Registration			7/15/2019 10:43 AM
Terminations	Termination Comments	Insert	New Registration			7/15/2019 10:43 AM
Terminations	Termination Date	Insert	New Registration			7/15/2019 10:43 AM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2019 10:43 AM
Terminations	Termination Reason	Insert	New Registration			7/15/2019 10:43 AM