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DSH370211 INTEGRIS CANADIAN VALLEY HOSPITAL (Active)
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Main Details
Name
INTEGRIS CANADIAN VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370211
Medicare Provider Number
370211
Additional Details
Current Program Status
Active
Registration Date
1/6/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/9/2023
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
1201 HEALTH CARE PARKWAY
YUKON, OK 73099
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2011; Terminated 1/1/2020; Reinstated 4/1/2023.
01/09/2023
12/14/10 DOC RECD TO CONFIRM ELIG DSH ADJ %
12/14/2010
April 2025
April 2025
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