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DSH370054A Grady Memorial Hospital (Terminated)
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Main Details
Name
Grady Memorial Hospital
Subdivision Name
Rush Springs Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370054A
Medicare Provider Number
370054
Outpatient Facility Provider Number
373449
Additional Details
Current Program Status
Terminated
Registration Date
5/25/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/20/2012
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
1/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Grady Memorial Hospital
KEAN SPELLMAN, CEO
(405) 779-2150
Primary Contact
Grady Memorial Hospital
Michael D Beard, Director of Pharmacy
(405) 779-2262
Addresses
Street Address
2220 W. Iowa
Chickasha, OK 73018
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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