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DSH370028F INTEGRIS BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
INTEGRIS BAPTIST MEDICAL CENTER
Subdivision Name
INTEGRIS Baptist Medical Center - Kidney Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370028F
Medicare Provider Number
370028
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
1/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
INTEGRIS Health System
Chris Hammes, Executive Vice President
(405) 949-3400
Primary Contact
INTEGRIS Health
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842
Addresses
Street Address
3400 NW EXPRESSWAY SUITE 700
INTEGRIS BAPTIST MEDICAL CENTER
OKLAHOMA CITY, OK 73112-4481
Billing Address
INTEGRIS Baptist Medical Center - Kidney Clinic
PO Box 268907
Oklahoma City, OK 73126-8907
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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