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DSH370054B GRADY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GRADY MEMORIAL HOSPITAL
Subdivision Name
FIVE OAKS FAMILY MEDICAL CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370054B
Medicare Provider Number
370054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/3/2015
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
2100 W IOWA AVE
CHICKASHA, OK 73018-2736
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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