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SCH370113-00 INTEGRIS GROVE HOSPITAL (Terminated)
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Main Details
Name
INTEGRIS GROVE HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH370113-00
Medicare Provider Number
370113
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/7/2019
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
1/1/2022
Change of covered entity type
Contacts
Authorizing Official
INTEGRIS Health System
Chris Hammes, Executive Vice President
(405) 949-3400
Primary Contact
Integris Health
Anja Wilkinson, 340B Compliance Director
(918) 231-6358
Addresses
Street Address
1001 EAST 18TH STREET
GROVE, OK 74344
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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