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OKLAHOMA CVS PHARMACY, L.L.C.
DSH370037 SSM ST ANTHONY HOSPITAL
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Covered Entity Details
Entity Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370037
Entity Address
1000 N Lee Ave
OKLAHOMA CITY, OK 73102
Medicare Provider Number
370037
Participating Start Date
10/1/2006
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06235
106 W HWY 152
MUSTANG, OK 73064
Pharmacy Comments
Contract Details
Approval Date
7/19/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/19/2018
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