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DSH370078A OKLAHOMA STATE UNIVERSITY MEDICAL CENTER TRUST (Terminated)
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Main Details
Name
OKLAHOMA STATE UNIVERSITY MEDICAL CENTER TRUST
Subdivision Name
Oklahoma State University Medical Center - Outpatient Dialysis Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH370078A
Medicare Provider Number
370078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/3/2020
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
4/1/2025
Site closure
Contacts
Authorizing Official
Oklahoma State University Medical Center
Eric Atkinson, Chief Financial Officer
(918) 599-5147
Primary Contact
Oklahoma State University Medical Center
John Bury, DIRECTOR OF PHARMACY
(918) 599-5565
Addresses
Street Address
744 West 9th St
Tulsa, OK 74127
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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