340B Drug Pricing Program Database


DSH370093 OU MEDICAL CENTER (Active) - information as of 4/25/2025 6:29:38 PM

Main Details
OU MEDICAL CENTER
Disproportionate Share Hospital
No
DSH370093
370093


Additional Details
Active
4/3/2018
7/1/2018
4/17/2018
9/4/2024

Contacts

OU Health
Krystal L Murer, Vice President | Ethics, Regulatory Affairs, and Chief Compliance Officer
(405) 271-8052

OU Health
Oliver Lackey, 340B Director
(405) 543-7101

Addresses

700 NE 13TH ST.
OKLAHOMA CITY, OK 73104

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Initial start 8/1/1993, Termination 1/1/2001, Reinstate 7/1/2018. The 340B ID was changed to align with MPN on MCR and IRS document. 04/17/2018
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OK200623940A,200300730A,200021910H,200300730E,200300730C,200300730 E,200532040A,200532040D,200752850C,200752850A1649794157,1598289902,1609390111
Shipping Addresses

OU Medicine Inc
1200 Everett Dr
Oklahoma City, OK 73104

OU Medicine Inc. Pharmacy
700 NE 13th Street
Oklahoma City, OK 73104

OU Medicine Inc
1001 N Lincoln Ave
Oklahoma City, OK 73104

OU Health Stephenson Cancer Center Pharmacy
800 NE 10th Street, Suite 1044
Oklahoma City, OK 73104

Oklahoma Children's Hospital Pharmacy
1200 Children's Avenue, Suite 2A
Oklahoma City, OK 73104

OU Health Physician Building Pharmacy
825 NE 10th Street, STE 2A
Oklahoma City, OK 73104-5417

Oklahoma Children's Hospital OU Health Pharmacy
1200 Childrens Avenue
Oklahoma City, OK 73104

OU Health Pharmacy - Nicholson Tower
1000 NE 13th St Suite 1880
Oklahoma City, OK 73104-5040

Jimmy Everest Cancer Center Pharmacy
1200 Childrens Ave, RM 7303 & 7305
Oklahoma City, OK 73104

Oklahoma University Stephenson Cancer Center
835 Stanton L Young BLVD
Oklahoma City, OK 73104
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACARIAHEALTH PHARMACY #11, INC1311 W SAM HOUSTON PKWY N STE 130
HOUSTONTX77043-401504/15/202407/01/2024 10/28/202404/03/2025
Contract DetailACARIAHEALTH PHARMACY #26, INC8715 HENDERSON RD
TAMPAFL3363404/15/202407/01/2024 10/28/202404/03/2025
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/12/201801/01/2019  04/15/2024
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/12/201801/01/2019  04/15/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/12/201801/01/2019  04/15/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/12/201801/01/2019 01/01/201901/04/2019
Contract DetailACCREDO HEALTH GROUP INC4901 W RENO AVE STE 950
OKLAHOMA CITYOK73127-639410/15/202110/15/2021  04/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624110/12/201801/01/2019 07/01/202304/12/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/12/201801/01/2019  04/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/12/201801/01/2019  04/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621510/15/202110/15/2021  04/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/17/202305/03/2023  04/15/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/04/202507/01/2025  04/04/2025
Contract DetailBIOLOGICS, INC.BIOLOGICS BY MCKESSON 11800 WESTON PARKWAY
CARYNC2751310/15/202010/27/2020  10/27/2020
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526110/13/202010/27/2020  10/27/2020
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771310/13/202010/27/2020  10/27/2020
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522607/17/202410/01/2024  10/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620307/17/202410/01/2024  10/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK PUERTO RICO SPECIALTY PHARMACY,CAREMARK PUERTO RICO SPECIALTY PHARMACY 6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINAPR0098210/13/202010/27/2020 11/14/202202/16/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/13/202010/27/2020  10/27/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/13/202010/27/2020  10/27/2020
Contract DetailCENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506910/13/202010/27/2020 01/24/202401/24/2024
Contract DetailCENTERWELL PHARMACY, INC.10737 MARKS WAY
MIRAMARFL3302510/13/202010/27/2020 01/24/202401/24/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 2345 WATERS DRIVE
MENDOTA HEIGHTSMN5512010/13/202010/27/2020  10/27/2020
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 11 H COMMERCE WAY
TOTOWANJ0751210/13/202010/27/2020 09/04/202209/11/2023
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 7400 WASHINGTON STREET NE
ALBUQUERQUENM8710910/13/202010/27/2020 07/23/202410/11/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 7358 S W DURHAM ROAD
PORTLANDOR9722410/13/202010/27/2020 07/23/202410/11/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 1471 E BUSINESS CENTER DRIVE
SUITE 500 		MOUNT PROSPECTIL6005610/13/202010/27/2020 01/17/202504/03/2025
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 10611 S. SAM HOUSTON PKWY WEST
SUITE 200 		HOUSTONTX77071-314010/13/202010/27/2020 07/23/202410/11/2024
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SVCS 5924 NW 2ND STREET SUITE 100
OKLAHOMA CITYOK73127-651410/13/202010/27/2020 01/17/202504/03/2025
Contract DetailCORAM HEALTHCARE CORPORATION OF FLORIDADBA CORAM CVS/SPECIALTY INFUSION SERVICE 8508 BENJAMIN RD
SUITE C 		TAMPAFL33634-124110/13/202010/27/2020 07/23/202410/11/2024
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/13/202010/27/2020  10/27/2020
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/18/201807/01/2018  04/18/2018
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/13/202010/27/2020 11/09/202102/10/2023
Contract DetailDOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654010/13/202010/27/2020 07/01/202407/09/2024
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/04/201904/01/2019  04/01/2019
Contract DetailEXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389610/13/202010/27/2020 07/01/202407/09/2024
Contract DetailEXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412510/13/202010/27/2020 07/01/202407/09/2024
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/04/201904/01/2019  04/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/04/201904/01/2019  04/01/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/04/201904/01/2019  04/01/2019
Contract DetailFOUNDATION CARE LLC111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELDMO6300504/15/202407/01/2024 10/28/202404/03/2025
Contract DetailIgG of America, Inc514 Progress Dr Suite X
LinthicumMD2109010/13/202010/27/2020 10/20/202111/03/2021
Contract DetailMAXOR SPECIALTY PHARMACY216 S POLK ST
AMARILLOTX79101-140704/14/202107/01/2021  07/01/2021
Contract DetailMAXOR SPECIALTY PHARMACY6101 43RD ST, STE C
LUBBOCKTX7940701/12/202404/01/2024  04/01/2024
Contract DetailMAXOR SPECIALTY PHARMACY150 CLEVELAND RD SUITE B
BOGARTGA30622-170101/12/202404/01/2024  04/01/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06224 1802 SOUTH 4TH ST.
CHICKASHAOK7301810/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06072 10800 N ROCKWELL AVE
OKLAHOMA CITYOK7316210/13/202010/27/2020 07/25/202410/11/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06003 4026 N MACARTHUR BLVD
WARR ACRESOK7312210/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06235 106 W HWY 152
MUSTANGOK7306410/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06096 1301 N SANTA FE AVE
EDMONDOK7300310/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06231 4500 NW 23RD ST
OKLAHOMA CITYOK7312710/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10274 1520 WEST ELK AVE.
DUNCANOK7353310/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06010 2412 N CLASSEN BLVD
OKLAHOMA CITYOK7310610/13/202010/27/2020 05/16/202410/11/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS PHARMACY # 16736 13924 N PENNSYLVANIA AVE
OKLAHOMA CITYOK7313410/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06016 9001 S WESTERN AVE
OKLAHOMA CITYOK7313910/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06230 715 NW 50TH ST.
OKLAHOMA CITYOK7311810/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08314 1040 SW 19TH ST.
MOOREOK7316010/13/202010/27/2020 11/14/202204/15/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06006 6951 SE 15TH ST
MIDWEST CITYOK7311010/13/202010/27/2020 04/12/202104/14/2021
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS PHARMACY # 17513 1700 GARTH BROOKS BLVD
YUKONOK7309910/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06022 12301 N MAY AVE
OKLAHOMA CITYOK7312010/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06021 800 SE 4TH ST
MOOREOK7316010/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06226 2323 N MARTIN LUTHER KING AVE
OKLAHOMA CITYOK7311110/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06236 2100 SW 119TH ST
OKLAHOMA CITYOK7317010/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06225 1520 S. BRYANT AVE.
EDMONDOK7301310/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02489 100 S. DOUGLAS BLVD.
MIDWEST CITYOK7313010/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06165 3651 W ROBINSON ST
NORMANOK7307210/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05959 900 SW 44TH ST
OKLAHOMA CITYOK7310910/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06020 5903 NORTHWEST EXPRESSWAY
WARR ACRESOK7313210/13/202010/27/2020 06/07/202210/11/2024
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06109 2350 N. HARPER ST., POBOX1009
CHOCTAWOK7302010/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.CVS PHARMACY # 16980 8315 N ROCKWELL AVE
OKLAHOMA CITYOK7313210/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04319 7925 NW EXPRESSWAY
OKLAHOMA CITYOK7313210/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06222 1220 N. COMMERCE ST.
ARDMOREOK7340110/13/202010/27/2020  10/27/2020
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06015 4251 SE 44TH ST
DEL CITYOK7313510/13/202010/27/2020 07/24/202309/05/2023
Contract DetailOKLAHOMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03883 9000 S. MAY AVE.
OKLAHOMA CITYOK7315910/13/202010/27/2020  10/27/2020
Contract DetailONCO360SINA DRUG, LLC 4700 W SAM HOUSTON PKWY N
STE 150 		HOUSTONTX7704110/11/202401/01/2025  01/01/2025
Contract DetailOPTIONONE, LLC14000 N PORTLAND AVE STE 205
OKLAHOMA CITYOK73134-402504/18/201807/01/2018 06/01/202407/09/2024
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/07/201901/01/2020 08/31/202009/09/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191301/12/202404/01/2024  04/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260101/12/202404/01/2024  04/01/2024
Contract DetailOPTUM INFUSION SERVICES 301, LP7512 NORTH BROADWAY EXT STE 308
OKLAHOMA CITYOK73116-905504/14/202107/01/2021 01/01/202302/06/2023
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/14/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/18/202201/20/2022  01/20/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/18/202201/20/2022  01/20/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/12/202404/01/2024  04/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/07/201901/01/2020  01/01/2020
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824910/07/201901/01/2020  01/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265510/07/201901/01/2020  01/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729801/18/202201/20/2022  01/20/2022
Contract DetailOPTUM PHARMACY 800, INC.3016 GUADALUPE ST STE A
AUSTINTX78705-286110/07/201901/01/2020 06/29/202106/29/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/07/201901/01/2020  01/01/2020
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/13/202110/14/2021  10/14/2021
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660801/18/202201/20/2022 01/01/202302/06/2023
Contract DetailOU CHILDREN'S PHARMACYBD OF REGENTS OF THE UNIV. OF OKLAHOMA 1200 CHILDRENS AVE STE 2A
OKLAHOMA CITYOK73104-463704/18/201807/01/2018 12/01/202112/09/2021
Contract DetailOU PHARMACISTS CARE CENTER825 NE 10TH ST STE 2A
OKLAHOMA CITYOK73104-541704/18/201807/01/2018 07/14/202207/21/2022
Contract DetailPEGGY & CHARLES STEPHENSON OKLA CANCER C800 NE 10TH ST STE 1044
OKLAHOMA CITYOK73104-541810/12/201801/01/2019 12/01/202112/09/2021
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999204/18/201807/01/2018 10/01/202204/15/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/13/202010/27/2020  10/27/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/13/202010/27/2020  10/27/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/13/202010/27/2020  10/27/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/13/202010/27/2020  10/27/2020
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255010/13/202010/27/2020 07/01/202407/09/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500210/13/202010/27/2020  10/27/2020
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104204/17/202305/03/2023  05/03/2023
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/17/202305/03/2023  05/03/2023
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202410/11/202401/01/2025  01/01/2025
Contract DetailUS BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501010/13/202010/27/2020 10/20/202110/20/2021
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/13/202010/27/2020 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-0103196 SHAWNEE MALL DR
SHAWNEEOK7480404/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-03891225 W I-35 FRONTAGE RD
EDMONDOK7303410/13/202010/27/2020 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-05445401 TINKER DIAGONAL ST.
DEL CITY(MWC)OK7311504/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-05646100 WEST RENO AVENUE
OKLAHOMA CITY (W)OK7312704/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-0743100 EAST I-240 SERVICES ROAD
OKLAHOMA CITY (S)OK7314904/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-10563300 NORTH TRI-CITY DR
NEWCASTLEOK7306510/13/202010/27/2020 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-23941500 SW 59TH STREET
OKLAHOMA CITYOK7311904/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-28032200 WEST DANFORTH ROAD
EDMOND (NW)OK7300304/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-28041801 BELLE ISLE BLVD
OKLAHOMA CITY (C)OK7311804/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-28761301 EAST 2ND STREET
EDMONDOK7303404/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-36152217 NORTHWEST 23RD STREET
OKLAHOMA CITY(23RD)OK7310704/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-53144420 S. WESTERN AVE
OKLAHOMA CITYOK73109-341404/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/13/202010/27/2020 03/15/202308/09/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07444 15100 N WESTERN AVE
EDMONDOK73013-110804/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03645 101 NORTH MIDWEST BLVD.
MIDWEST CITYOK7311004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03648 301 SOUTH SANTE FE AVENUE
EDMONDOK7300304/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04603 6000 S. PENNSYLVANIA
OKLAHOMA CITYOK7315904/18/201807/01/2018 12/27/202312/11/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09582 8917 NE 23RD ST
OKLAHOMA CITYOK7314104/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03668 7101 W. HEFNER RD.
OKLAHOMA CITYOK7316204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #12094 535 NW 9TH ST.
OKLAHOMA CITYOK73102-107004/18/201807/01/2018 07/22/201910/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 04011 2835 SW 29TH STREET
OKLAHOMA CITYOK7311904/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 05740 7930 NW EXPRESSWAY
OKLAHOMA CITYOK7313204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03718 6350 N. MACARTHUR
WARR ACRESOK7312204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03748 4300 SOUTHEAST 29TH ST
DEL CITYOK7311504/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03642 4500 SOUTH SHIELDS BLVD
OKLAHOMA CITYOK7312904/18/201807/01/2018 01/01/202412/11/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06436 1400 EAST SECOND ST
EDMONDOK73034-532104/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #10957 3232 TRI CITY DR.
NEWCASTLEOK7306504/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04066 1099 GARTH BROOKS BLVD.
YUKONOK7309904/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04896 185 E 33RD STREET
EDMONDOK7301304/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04098 5120 N MAY AVENUE
OKLAHOMA CITYOK7311204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #11095 5901 NW 122ND ST.
OKLAHOMA CITYOK7314204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 09223 9950 SE 15TH STREET
MIDWEST CITYOK7313004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 05738 1229 N EASTERN AVE
MOOREOK7316004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06834 4400 NW 23RD STREET
OKLAHOMA CITYOK73107-264404/18/201807/01/2018 10/01/202010/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 03643 9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITYOK7315904/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #10916 1621 S. DIVISION ST.
GUTHRIEOK7304404/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 02543 2345 N CLASSEN BLVD
OKLAHOMA CITYOK73106-580404/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 07222 112 E STATE HWY 152
MUSTANGOK73064-440204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06109 1640 SW 119TH STREET
OKLAHOMA CITYOK7317004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #10094 2675 NORTH KELLY AVENUE
EDMONDOK7300304/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16515 519 NW 23RD ST STE 109
OKLAHOMA CITYOK7310304/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04673 5901 NW 39TH ST
WARR ACRESOK7312204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 01423 2316 N ROCKWELL AVE
BETHANYOK7300804/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06834 4400 NW 23RD STREET
OKLAHOMA CITYOK73107-264404/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04895 2400 N MAY AVE
OKLAHOMA CITYOK7310704/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04784 2100 W BRITTON RD
OKLAHOMA CITYOK7312004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06477 615 W MAIN STREET
NORMANOK73069-706204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04111 12240 N. MAY AVE.
OKLAHOMA CITYOK7312004/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 09375 1041 S W 19TH ST
MOOREOK73160-280607/02/201910/01/2019  10/01/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 03786 1201 NW 12TH STREET
MOOREOK7317007/02/201910/01/2019 09/30/202412/11/2024
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16556 1611 E. 15TH ST.
TULSAOK7412004/14/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 03647 100 12TH AVENUE NE
NORMANOK7307110/13/202110/14/2021  10/14/2021
Contract DetailWalgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626210/13/202110/14/2021  10/14/2021
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528404/18/201807/01/2018 05/08/202407/09/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/18/201807/01/2018  04/18/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/18/201807/01/2018  04/18/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/18/201807/01/2018  04/18/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/18/201807/01/2018 10/07/201910/07/2019
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528604/18/201807/01/2018 10/07/201910/07/2019
Contract DetailWALMART PHARMACY 10-32024900 S. SOONER ROAD
OKLAHOMA CITYOK7313504/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWALMART PHARMACY 10-419514185 MACK HARRINGTON DRIVE
CHOCTAWOK7302004/14/202107/01/2021 03/15/202308/09/2023
Contract DetailWALMART PHARMACY 10-532313503 SOUTH SANTA FE AVE
OKLAHOMA CITYOK7317010/13/202010/27/2020 03/15/202308/09/2023
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH370093AChildDSHOU MEDICAL CENTEROU MEDICAL CENTER-THE CHILDREN'S HO - Rad CT1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AAChildDSHOU MEDICAL CENTEROU MEDICAL CENTER-THE CHILDREN'S HOSPITAL - Cath Lab1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093ABChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Special ProceduresONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093ACChildDSHOU MEDICAL CENTEROU Health Transplant Institute920 NE 13th StreetOKLAHOMA CITYOKActive
DSH370093ADChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Rad Diagnostic1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AEChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Emergency Room1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AFChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Anesthesia Childrens1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AGChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - OU Surgery Clinic711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093AHChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond EndoscopyONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093AJChildDSHOU MEDICAL CENTERBREAST HEALTH NETWORK EDMOND - Edmond Breast Health2601 KELLEY POINTE PKWYEDMONDOKActive
DSH370093AKChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Vascular Lab1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093ALChildDSHOU MEDICAL CENTEREDMOND MEDICAL OFFICE BUILDING - Senior Health Clinic Edmond105 SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093AMChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - EP LAB1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093ANChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - OU OBGYN Clinic711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093APChildDSHOU MEDICAL CENTERTHE CHILDREN's HOSPTIAL - Dialysis1200 CHILDRENS AVEOKLAHOMA CITYOKTerminated
DSH370093AQChildDSHOU MEDICAL CENTEROU MEDICAL CENTER CHILDREN'S PHYSI - Childrens Radiology1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093ARChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Emergency RoomONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093ASChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond MRIONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093ATChildDSHOU MEDICAL CENTERSCC Radiology Special Procedures800 NORTHEAST 10TH STREETOKLAHOMA CITYOKActive
DSH370093AUChildDSHOU MEDICAL CENTERBREAST HEALTH NETWORK - NW Breast Health Network13401 N MACARTHUR BLVDOKLAHOMA CITYOKActive
DSH370093AVChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - PT OT1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AWChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Physical TherapyONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093AXChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Rad Ultrasound1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093AYChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond HemodialysisONE SOUTH BRYANT AVENUEEDMONDOKTerminated
DSH370093AZChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond AnesthesiaONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093BChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond UltrasoundONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093BAChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Radiology DiagnosticONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093BBChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Respiratory Therapy1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BCChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Sleep LabONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093BDChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - Dialysis Peds1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BEChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Cath LabONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093BFChildDSHOU MEDICAL CENTEROU Physician's Building Imaging825 Northeast 10th StreetOKLAHOMA CITYOKActive
DSH370093BGChildDSHOU MEDICAL CENTEROU MEDICAL CENTER-Outpatient Surgery Center700 NORTH EAST 10TH STREETOKLAHOMA CITYOKActive
DSH370093BHChildDSHOU MEDICAL CENTEROU Physician's Building - Heart Lung Vascular (HLV) Clinic825 N.E. 10TH STREETOKLAHOMA CITYOKActive
DSH370093BJChildDSHOU MEDICAL CENTEROU Medical Center -Stephenson Cancer Center800 NE 10th StreetOklahoma CityOKActive
DSH370093BKChildDSHOU MEDICAL CENTEROU Medicine - Jimmy Everest Oncology Center1200 Children's AveOklahoma CityOKActive
DSH370093BLChildDSHOU MEDICAL CENTEREDMOND MEDICAL OFFICE BUILDING -Preoperative Clinic and Outpatient Lab - Preoperative Clinic and Outpatient Lab105 S. BryantEDMONDOKActive
DSH370093BMChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG -Medicine Specialty Clinic - Medicine Specialty Clinic711 STANTON L YOUNG BOULEVARDOklahoma CityOKActive
DSH370093BNChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - Orthopedic Clinic - Orthopedic Clinic711 STANTON L YOUNG BOULEVARDOklahoma CityOKActive
DSH370093BPChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Physical Therapy - Edmond Physical Therapy305 S. BryantEDMONDOKActive
DSH370093BQChildDSHOU MEDICAL CENTEROU MEDICAL CENTER - Radiation Annex - Radiation Annex825 NE 10th StreetOKLAHOMA CITYOKActive
DSH370093BRChildDSHOU MEDICAL CENTEROU CHILDRENS NEUROLOGY CLINIC - Children's Neurology Clinic1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BSChildDSHOU MEDICAL CENTEROU CHILDRENS HEART CENTER - Children's Heart Center1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BTChildDSHOU MEDICAL CENTEROU CHILDRENS SOONER PEDIATRIC CLIN - Sooner Pediatric Clinic1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BUChildDSHOU MEDICAL CENTEROU CHILDRENS NEUROSURGERY CLINIC - Children's Neurosurgery Clinic1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BVChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Outpatient Infusion Center - Edmond Outpatient Infusion CenterOne South BryantEdmondOKActive
DSH370093BWChildDSHOU MEDICAL CENTEROU CHILDRENS SPECIALTY CLINIC - Children's Specialty Clinic1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BXChildDSHOU MEDICAL CENTEROU CHILDRENS ADOLESCENT MEDICINE CL - Adolescent Medicine Clinic1200 CHILRENS AVEOKLAHOMA CITYOKActive
DSH370093BYChildDSHOU MEDICAL CENTEROU CHILDRENS GASTRO & HEPATOLOGY - OU Children's Physicians Building - Gastroenterology & Hepatology1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093BZChildDSHOU MEDICAL CENTEROU CHILDRENS PDP & CYSTIC FIBROSIS - OU Children's Physicians Building -Pulmonology & Cystic Fibrosis1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093CChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - OU Image Clinic711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093CAChildDSHOU MEDICAL CENTEROU CHILDREN'S DIABETES & ENDO - OU Children's Physicians Building - Diabetes & Endocrinology1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093CBChildDSHOU MEDICAL CENTEROU Health Physicians Building - Neurology Clinic - OU Health Physicians - Neurology Clinic825 NE 10th StreetOklahoma CityOKActive
DSH370093CCChildDSHOU MEDICAL CENTEROU Health ER & Urgent Care Yukon - OU Health ER & Urgent Care Yukon709 N. Czech Hall RoadYukonOKActive
DSH370093CDChildDSHOU MEDICAL CENTEROU Stephenson Cancer Center at Norman Regional - Medical Oncology Infusion - OU Stephenson Cancer Center at Norman Regional - Medical Oncology Infusion901 N. Porter AveNormanOKActive
DSH370093CEChildDSHOU MEDICAL CENTEROU Health Infectious Diseases Clinic - OU Health Infectious Diseases Clinic711 Stanton L. Young Blvd.Oklahoma CityOKActive
DSH370093CFChildDSHOU MEDICAL CENTEROU Health Reproductive Medicine - OU Health Reproductive Medicine840 Research ParkwayOklahoma CityOKActive
DSH370093CGChildDSHOU MEDICAL CENTEROU Health Pre-Op Clinic - OU Health Pre-Op Clinic711 Stanton L. Young Blvd.Oklahoma CityOKActive
DSH370093CHChildDSHOU MEDICAL CENTEROU Health GIM/Medicine Specialty/Senior Health Clinic - OU Health GIM/Medicine Specialty/Senior Health Clinic1000 NE 13th StreetOklahoma CityOKActive
DSH370093CJChildDSHOU MEDICAL CENTEROU HEALTH DERMATOLOGY CLINIC - OU HEALTH DERMATOLOGY CLINIC1000 NE 13TH STOKLAHOMA CITYOKActive
DSH370093CKChildDSHOU MEDICAL CENTEROU Stephenson Cancer Center at Norman Regional - Medical Oncology Clinical - OU Stephenson Cancer Center at Norman Regional - Medical Oncology Clinical901 N. Porter AveNormanOKActive
DSH370093CLChildDSHOU MEDICAL CENTEROU HEALTH SCC AT SCHUSTERMAN - Oncology4444 E 41ST STTULSAOKActive
DSH370093CMChildDSHOU MEDICAL CENTEROU HEALTH ER & URGENT CARE - SOUTH - Urgent Care3025 SW 104TH STOKLAHOMA CITYOKActive
DSH370093CNChildDSHOU MEDICAL CENTEROU HEALTH SCC AT HILLCREST - Hillcrest Infusion1245 S UTICA AVETULSAOKActive
DSH370093CPChildDSHOU MEDICAL CENTEROU HEALTH EDMOND GASTROENTEROLOGY - Gastroenterology105 S BRYANT AVEEDMONDOKActive
DSH370093DChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond LaboratoryONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093EChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond EEGONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093FChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - OU Medicine Clinic711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093GChildDSHOU MEDICAL CENTEROUMC Outpatient Clinic1122 N.E. 13TH STREETOKLAHOMA CITYOKTerminated
DSH370093HChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond CT ScanONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093JChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Respiratory TherapyONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093KChildDSHOU MEDICAL CENTERTHE CHILDREN'S HOSPITAL - EEG1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093LChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG PAIN MANAGEMENT & SURGERY CLINIC I711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093MChildDSHOU MEDICAL CENTEROU MEDICAL CENTER CHILDREN'S PHYSI - Peds Echo1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093NChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond RecoveryONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093PChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond SurgeryONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093QChildDSHOU MEDICAL CENTERBREAST HEALTH NETWORK - SW Breast Health Network2607 SW 119TH STOKLAHOMA CITYOKActive
DSH370093RChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond Nuclear MedicineONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093SChildDSHOU MEDICAL CENTERThe Children's Hospital - Sleep Lab1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093TChildDSHOU MEDICAL CENTERThe Children's Hospital - Rad Ther1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093UChildDSHOU MEDICAL CENTEROUCPB- Peds EKG1200 CHILDRENS AVEOKLAHOMA CITYOKActive
DSH370093WChildDSHOU MEDICAL CENTEROU MEDICAL CENTER- PRESBY PROF BLDG - ORL & Plastic Surgery Clinic711 STANTON L YOUNG BOULEVARDOKLAHOMA CITYOKActive
DSH370093XChildDSHOU MEDICAL CENTEREDMOND MEDICAL OFFICE BUILDING - Edmond Radiology Clinic105 SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093YChildDSHOU MEDICAL CENTEROU MEDICAL CENTER EDMOND - Edmond EKGONE SOUTH BRYANT AVENUEEDMONDOKActive
DSH370093ZChildDSHOU MEDICAL CENTEROU PHYSICIANS BUILDING - Endoscopy825 NORTHEAST 10TH STREETOKLAHOMA CITYOKActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/8/2025 10:10 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200752850C4/8/2025 10:10 AM
Medicaid BillingMedicaid: StateInsertChange Request OK4/8/2025 10:10 AM
ContactsPrimary ContactUpdateChange RequestWeckhorst, Kaitlyn 340B Manager OU Health 4056583226Lackey, Oliver 340B Director OU Health 40554371014/4/2025 9:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/18/2025 9:48 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200532040D2/18/2025 9:48 AM
Medicaid BillingMedicaid: StateInsertChange Request OK2/18/2025 9:48 AM
AddressesShipping AddressInsertChange Request Oklahoma University Stephenson Cancer Center 835 Stanton L Young BLVD Oklahoma City, OK 731042/7/2025 7:38 AM
ContactsPrimary ContactUpdateChange RequestHale, Stacey D Director, 340B Program OU Medicine 4056152194Weckhorst, Kaitlyn 340B Manager OU Health 405658322612/30/2024 12:33 PM
DetailsLast Recertification DateUpdateRecertification8/23/2023 4:03:19 PM9/4/2024 10:11:53 AM9/4/2024 10:11 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestMurer, Krystal Leighanna Associate Vice President | Ethics, Regulatory Affairs, and Compliance Officer OU Health 4052718052Murer, Krystal L Vice President | Ethics, Regulatory Affairs, and Chief Compliance Officer OU Health 40527180524/29/2024 6:36 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/28/2023 10:45 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200300730C12/28/2023 10:45 AM
Medicaid BillingMedicaid: StateInsertChange Request OK12/28/2023 10:45 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/28/2023 10:45 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200300730 E12/28/2023 10:45 AM
Medicaid BillingMedicaid: StateInsertChange Request OK12/28/2023 10:45 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/28/2023 10:45 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200532040A12/28/2023 10:45 AM
Medicaid BillingMedicaid: StateInsertChange Request OK12/28/2023 10:45 AM
DetailsLast Recertification DateUpdateRecertification9/9/2022 11:35:08 AM8/23/2023 4:03:19 PM8/23/2023 4:03 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/21/2023 3:56 PM
Medicaid BillingMedicaid: NumberInsertChange Request 200300730E7/21/2023 3:56 PM
Medicaid BillingMedicaid: StateInsertChange Request OK7/21/2023 3:56 PM
AddressesShipping AddressInsertChange Request Jimmy Everest Cancer Center Pharmacy 1200 Childrens Ave, RM 7303 & 7305 Oklahoma City, OK 731041/9/2023 7:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/9/2023 7:33 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200021910H1/9/2023 7:33 AM
Medicaid BillingMedicaid: StateInsertChange Request OK1/9/2023 7:33 AM
AddressesShipping AddressInsertChange Request OU Health Pharmacy - Nicholson Tower 1000 NE 13th St Suite 1880 Oklahoma City, OK 73104-50409/29/2022 9:56 AM
AddressesShipping AddressInsertChange Request Oklahoma Children's Hospital OU Health Pharmacy 1200 Childrens Avenue Oklahoma City, OK 731049/13/2022 11:17 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 9:25:59 AM9/9/2022 11:35:08 AM9/9/2022 11:35 AM
AddressesShipping AddressInsertChange Request OU Health Physician Building Pharmacy 825 NE 10th Street, STE 2A Oklahoma City, OK 73104-54177/21/2022 10:57 AM
ContactsAuthorizing OfficialUpdateChange RequestWatson, James Michael CFO OU Medicine Inc. 4052715100Murer, Krystal Leighanna Associate Vice President | Ethics, Regulatory Affairs, and Compliance Officer OU Health 40527180527/21/2022 10:57 AM
ContactsPrimary ContactUpdateGroup Change RequestHerring, Holly AVP Pharmacy OU Health 5805127188Hale, Stacey D Director, 340B Program OU Medicine 40561521947/19/2022 6:48 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/5/2022 11:06 AM
Medicaid BillingMedicaid: NumberInsertChange Request 200300730A7/5/2022 11:06 AM
Medicaid BillingMedicaid: StateInsertChange Request OK7/5/2022 11:06 AM
AddressesShipping AddressDeleteChange RequestOU Health Pharmacy OU Health Family Medicine 900 NE 10TH Street, Suite 1101 Oklahoma City, OK 73104 1/18/2022 2:59 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/18/2022 2:59 PM
Medicaid BillingMedicaid: NumberInsertChange Request 200623940A1/18/2022 2:59 PM
Medicaid BillingMedicaid: StateInsertChange Request OK1/18/2022 2:59 PM
AddressesShipping AddressInsertChange Request OU Health Stephenson Cancer Center Pharmacy 800 NE 10th Street, Suite 1044 Oklahoma City, OK 7310412/15/2021 6:16 AM
AddressesShipping AddressInsertChange Request OU Health Pharmacy OU Health Family Medicine 900 NE 10TH Street, Suite 1101 Oklahoma City, OK 7310412/15/2021 6:16 AM
AddressesShipping AddressInsertChange Request Oklahoma Children's Hospital Pharmacy 1200 Children's Avenue, Suite 2A Oklahoma City, OK 7310412/15/2021 6:16 AM
ContactsPrimary ContactUpdateRecertificationHerring, PharmD BCPS, Holly R 340B Compliance Manager OU Medicine 4052718001-32069Herring, Holly AVP Pharmacy OU Health 58051271889/9/2021 9:25 AM
DetailsLast Recertification DateUpdateRecertification8/28/2020 1:26:52 PM9/9/2021 9:25:59 AM9/9/2021 9:25 AM
Medicaid BillingNPI: StateUpdateRecertification OK8/28/2020 1:26 PM
Medicaid BillingNPI: StateUpdateRecertification OK8/28/2020 1:26 PM
Medicaid BillingNPI: StateUpdateRecertification OK8/28/2020 1:26 PM
DetailsLast Recertification DateUpdateRecertification8/21/2019 1:40:42 PM8/28/2020 1:26:52 PM8/28/2020 1:26 PM
ContactsPrimary ContactUpdateChange RequestPezewski, David Ian Director of Reimbursement OU Medicine Inc 4052718132-53399Herring, PharmD BCPS, Holly R 340B Compliance Manager OU Medicine 4052718001-320697/22/2020 8:14 AM
AddressesShipping AddressInsertChange Request OU Medicine Inc 1001 N Lincoln Ave Oklahoma City, OK 731045/8/2020 7:59 AM
DetailsLast Recertification DateUpdateRecertification8/15/2018 10:32:25 AM8/21/2019 1:40:42 PM8/21/2019 1:40 PM
DetailsLast Recertification DateUpdateRecertification 8/15/2018 10:32:25 AM8/15/2018 10:32 AM
AddressesMain AddressUpdateChange Request 700 NE 13TH ST. OKLAHOMA CITY, OK 73126 700 NE 13TH ST. OKLAHOMA CITY, OK 731048/13/2018 10:44 AM
TerminationsTermination ReasonUpdate For-Profit conversion 7/21/2018 12:21 PM
AddressesMain AddressUpdateChange Request 800 NE 13TH ST. OKLAHOMA CITY, OK 73126 700 NE 13TH ST. OKLAHOMA CITY, OK 731266/28/2018 9:23 AM
ContactsPrimary ContactUpdateChange RequestJones, Mary Lucille Dir Revenue Integrity OU Medicine Inc 4052718132-53365Pezewski, David Ian Director of Reimbursement OU Medicine Inc 4052718132-533996/28/2018 9:23 AM
DetailsStateUpdateChange RequestApprovedActive6/28/2018 9:23 AM
DetailsEntity NameUpdateOPA EditUNIVERSITY HOSPITAL HLTH SOURCE PHARMACYOU MEDICAL CENTER4/18/2018 12:21 PM
DetailsEntity SubnameUpdateOPA EditOKLAHOMA MEDICAL CENTER 4/18/2018 12:21 PM
AddressesShipping AddressInsertReinstatement OU Medicine Inc 1200 Everett Dr Oklahoma City, OK 731044/17/2018 2:25 PM
AddressesShipping AddressInsertReinstatement OU Medicine Inc. Pharmacy 700 NE 13th Street Oklahoma City, OK 731044/17/2018 2:25 PM
ContactsPrimary ContactInsertReinstatement Jones, Mary Lucille Dir Revenue Integrity OU Medicine Inc 4052718132-533654/17/2018 2:25 PM
ContactsAuthorizing OfficialInsertReinstatement Watson, James Michael CFO OU Medicine Inc. 40527151004/17/2018 2:25 PM
ContactsSigned ByInsertReinstatement Watson, James Michael CFO OU Medicine Inc. 40527151004/17/2018 2:25 PM
Details340B IDUpdateReinstatementDSH8412DSH3700934/17/2018 2:25 PM
DatesParticipating Approval DateUpdateReinstatement 4/17/2018 2:25:17 PM4/17/2018 2:25 PM
DetailsStateUpdateReinstatementPendingApproved4/17/2018 2:25 PM
DatesSigned By DateUpdateReinstatement 4/9/2018 4:51:01 PM4/17/2018 2:25 PM
DatesStart DateUpdateReinstatement 7/1/2018 12:00:00 AM4/17/2018 2:25 PM
TerminationsTermination ReasonUpdateReinstatement For-Profit conversion4/17/2018 2:25 PM
DetailsComments PublicInsertReinstatement Initial start 8/1/1993, Termination 1/1/2001, Reinstate 7/1/2018. The 340B ID was changed to align with MPN on MCR and IRS document. 4/17/2018 2:13 PM
Medicaid BillingMedicaid: NumberUpdateReinstatement90003924206200752850A4/3/2018 4:33 PM
Medicaid BillingNPI: NumberInsertReinstatement 16497941574/3/2018 4:33 PM
Medicaid BillingNPI: NumberInsertReinstatement 15982899024/3/2018 4:33 PM
Medicaid BillingNPI: NumberInsertReinstatement 16093901114/3/2018 4:33 PM
DatesParticipating Approval DateUpdateReinstatement8/1/1993 12:00:00 AM 4/3/2018 12:33 PM
DetailsStateUpdateReinstatementTerminatedPending4/3/2018 12:33 PM
DatesRegistration DateUpdateReinstatement8/1/1993 12:00:00 AM4/3/2018 12:33:06 PM4/3/2018 12:33 PM
DatesStart DateUpdateReinstatement8/1/1993 12:00:00 AM 4/3/2018 12:33 PM
TerminationsTermination DateUpdateReinstatement1/1/2001 12:00:00 AM 4/3/2018 12:33 PM
TerminationsTermination ReasonUpdateReinstatementFor-Profit conversion 4/3/2018 12:33 PM
AddressesMain AddressInsert   800 NE 13TH ST. OKLAHOMA CITY, OK 731269/19/2005 2:42 PM
DetailsLast Recertification DateInsert   9/19/2005 2:42 PM
DetailsGrant NumberInsert   9/19/2005 2:42 PM
Details340B IDInsert  DSH84129/19/2005 2:42 PM
DetailsIs Authorizing Official EHB DataInsert   9/19/2005 2:42 PM
DatesLast Date That 340B Drugs PurchasedInsert   9/19/2005 2:42 PM
DetailsMedicare Provider NumberInsert  3700939/19/2005 2:42 PM
DetailsEntity NameInsert  UNIVERSITY HOSPITAL HLTH SOURCE PHARMACY9/19/2005 2:42 PM
DetailsProgram CodeInsert  DSH9/19/2005 2:42 PM
DetailsEntity SubnameInsert  OKLAHOMA MEDICAL CENTER9/19/2005 2:42 PM
DatesParticipating Approval DateInsert  8/1/1993 12:00:00 AM9/19/2005 2:42 PM
DetailsStateInsert  Terminated9/19/2005 2:42 PM
DatesRegistration DateInsert  8/1/1993 12:00:00 AM9/19/2005 2:42 PM
DatesSigned By DateInsert   9/19/2005 2:42 PM
DatesStart DateInsert  8/1/1993 12:00:00 AM9/19/2005 2:42 PM
TerminationsTermination CommentsInsert   9/19/2005 2:42 PM
TerminationsTermination DateInsert  1/1/2001 12:00:00 AM9/19/2005 2:42 PM
TerminationsTermination Effective DateInsert   9/19/2005 2:42 PM
TerminationsTermination ReasonInsert  For-Profit conversion9/19/2005 2:42 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True8/1/1993 12:00 AM
Medicaid BillingMedicaid: NumberInsert  900039242068/1/1993 12:00 AM
Medicaid BillingMedicaid: StateInsert  OK8/1/1993 12:00 AM