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THE CLINIC PHARMACY
DSH370149 St Anthony Shawnee Hospital
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Covered Entity Details
Entity Name
St Anthony Shawnee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370149
Entity Address
1102 West MacArthur St
SHAWNEE, OK 74804
Medicare Provider Number
370149
Participating Start Date
4/1/2010
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
THE CLINIC PHARMACY
Pharmacy Address
BARRICK PHARMACIES, INC.
3210 KETHLEY RD
SHAWNEE, OK 74804-9625
Pharmacy Comments
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Ownership change
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
The Clinic Pharmacy
Tim Barrick, Owner
(405) 273-9417
Signed By Date
10/7/2019
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