340B Drug Pricing Program Database
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DSH370028AV INTEGRIS BAPTIST MEDICAL CENTER (Active)
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Main Details
Name
INTEGRIS BAPTIST MEDICAL CENTER
Subdivision Name
INTEGRIS CANCER INSTITUTE OF OKLAHOMA - COMPUTED TOMOGRAPHY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370028AV
Medicare Provider Number
370028
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/20/2019
Participating Start Date
1/1/2020
Participating Approval Date
12/26/2019
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
INTEGRIS Health
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842
Primary Contact
INTEGRIS Health
Christopher K. Yang, 340B Coordinator
(405) 795-2545
Addresses
Street Address
5911 WEST MEMORIAL ROAD
OKLAHOMA CITY, OK 73142
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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