Covered Entity Details

DSH370016G INTEGRIS HEALTH ENID HOSPITAL (Active) - information as of 5/5/2025 11:56:06 PM

Main Details

Name

INTEGRIS HEALTH ENID HOSPITAL

Subdivision Name

INTEGRIS HEART AND VASCULAR INSTITUTE - COMPUTED TOMOGRAPHY

Type

Disproportionate Share Hospital

Rural

340B ID

DSH370016G

Medicare Provider Number

370016

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2020

Participating Start Date

7/1/2020

Participating Approval Date

5/27/2020

Last Recertification Date

8/20/2024

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

707 S MONROE ST
ENID, OK 73701-7286

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	100699500A	1144236571

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
DSH370016A	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITUTE OF NORTHWEST OKLAHOMA	707 S. Monroe	Enid	OK	Active
DSH370016B	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEALTH ENID HOSPITAL - SLEEP MEDICINE	401 SOUTH THIRD ST	Enid	OK	Active
DSH370016C	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITUTE - GASTROENTEROLOGY	707 S MONROE ST	ENID	OK	Active
DSH370016D	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITU - Cardiovascular Ultrasound	707 S MONROE ST	ENID	OK	Active
DSH370016E	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITUTE - RADIOLOGY DIAGNOSTIC	707 S MONROE ST	ENID	OK	Active
DSH370016F	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITUTE - NUCLEAR MEDICINE	707 S MONROE ST	ENID	OK	Active
DSH370016G	Child	DSH	INTEGRIS HEALTH ENID HOSPITAL	INTEGRIS HEART AND VASCULAR INSTITUTE - COMPUTED TOMOGRAPHY	707 S MONROE ST	ENID	OK	Active

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 8:00 AM
Details	Last Recertification Date	Update	Recertification	8/20/2023 10:34:20 PM	8/20/2024 12:43:36 PM	8/20/2024 12:43 PM
Details	Entity Subname	Update	Recertification	INTEGRIS HEART AND VASCULAR INSTITU - Computed Tomography	INTEGRIS HEART AND VASCULAR INSTITUTE - COMPUTED TOMOGRAPHY	8/20/2024 12:43 PM
Details	Entity Name	Update	Change Request	INTEGRIS BASS BAPTIST HEALTH CENTER	INTEGRIS HEALTH ENID HOSPITAL	5/27/2024 8:50 AM
Contacts	Primary Contact	Update	Group Change Request	Wilkinson, Anja 340B Compliance Director Integris Health 9182316358	Dooley, Ryan Dale 340B Compliance Manager INTEGRIS Health 4058026057	9/8/2023 7:33 AM
Details	Last Recertification Date	Update	Recertification	9/2/2022 9:37:36 AM	8/20/2023 10:34:20 PM	8/20/2023 10:34 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	9/9/2022 1:29 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:06:50 PM	9/2/2022 9:37:36 AM	9/2/2022 9:37 AM
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 12:14 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 3:49:01 PM	8/23/2021 2:06:50 PM	8/23/2021 2:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144236571	9/3/2020 3:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/3/2020 3:49 PM
Details	Last Recertification Date	Update	Recertification		9/3/2020 3:49:01 PM	9/3/2020 3:49 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	5/27/2020 12:29 PM
Details	340B ID	Update	New Registration		DSH370016G	5/27/2020 12:29 PM
Details	Entity Subname	Update	New Registration	INTEGRIS HEART AND VASCULAR INSTITU	INTEGRIS HEART AND VASCULAR INSTITU - Computed Tomography	5/27/2020 12:29 PM
Dates	Participating Approval Date	Update	New Registration		5/27/2020 12:29:04 PM	5/27/2020 12:29 PM
Details	State	Update	New Registration	Pending	Approved	5/27/2020 12:29 PM
Dates	Signed By Date	Update	New Registration		4/13/2020 1:49:06 PM	5/27/2020 12:29 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	5/27/2020 12:29 PM
Addresses	Main Address	Insert	New Registration		707 S MONROE ST ENID, OK 73701-7286	4/13/2020 10:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2020 10:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100699500A	4/13/2020 10:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	4/13/2020 10:52 AM
Contacts	Primary Contact	Insert	New Registration		Wilkinson, Anja 340B Compliance Director Integris Health 4056446998	4/13/2020 10:52 AM
Contacts	Authorizing Official	Insert	New Registration		Hammes, Chris Executive Vice President INTEGRIS Health System 4059493400	4/13/2020 10:52 AM
Details	Last Recertification Date	Insert	New Registration			4/13/2020 10:52 AM
Details	Grant Number	Insert	New Registration			4/13/2020 10:52 AM
Details	340B ID	Insert	New Registration			4/13/2020 10:52 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2020 10:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2020 10:52 AM
Details	Medicare Provider Number	Insert	New Registration		370016	4/13/2020 10:52 AM
Details	Entity Name	Insert	New Registration		INTEGRIS BASS BAPTIST HEALTH CENTER	4/13/2020 10:52 AM
Details	Program Code	Insert	New Registration		DSH	4/13/2020 10:52 AM
Details	Entity Subname	Insert	New Registration		INTEGRIS HEART AND VASCULAR INSTITU	4/13/2020 10:52 AM
Dates	Participating Approval Date	Insert	New Registration			4/13/2020 10:52 AM
Details	State	Insert	New Registration		Pending	4/13/2020 10:52 AM
Dates	Registration Date	Insert	New Registration		4/13/2020 10:52:31 AM	4/13/2020 10:52 AM
Dates	Signed By Date	Insert	New Registration			4/13/2020 10:52 AM
Dates	Start Date	Insert	New Registration			4/13/2020 10:52 AM
Terminations	Termination Comments	Insert	New Registration			4/13/2020 10:52 AM
Terminations	Termination Date	Insert	New Registration			4/13/2020 10:52 AM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2020 10:52 AM
Terminations	Termination Reason	Insert	New Registration			4/13/2020 10:52 AM