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DSH370093AY OU MEDICAL CENTER (Terminated)
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Main Details
Name
OU MEDICAL CENTER
Subdivision Name
OU MEDICAL CENTER EDMOND - Edmond Hemodialysis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370093AY
Medicare Provider Number
370093
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/20/2018
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
10/1/2020
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
OU Medicine Inc.
James Michael Watson, CFO
(405) 271-5100
Primary Contact
OU Medicine
Holly R Herring, PharmD BCPS, 340B Compliance Manager
(405) 271-8001 Ext: 32069
Addresses
Street Address
ONE SOUTH BRYANT AVENUE
EDMOND, OK 73034-6309
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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