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DSH370028AF INTEGRIS BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
INTEGRIS BAPTIST MEDICAL CENTER
Subdivision Name
Portland Avenue Campus - Labor & Delivery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370028AF
Medicare Provider Number
370028
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/19/2019
Participating Start Date
1/1/2020
Participating Approval Date
12/26/2019
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
1/1/2024
Site closure
Contacts
Authorizing Official
INTEGRIS Health
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842
Primary Contact
INTEGRIS Health
Ryan Dale Dooley, 340B Compliance Manager
(405) 802-6057
Addresses
Street Address
5501 N. Portland Ave
OKLAHOMA CITY, OK 73112
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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