Contract Pharmacy Details

WALGREEN CO.
DSH370106 INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

Covered Entity Details

Entity Name

INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370106

Entity Address

4401 SOUTH WESTERN AVE
OKLAHOMA CITY, OK 73109

Medicare Provider Number

370106

Participating Start Date

7/1/2009

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03643
9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITY, OK 73159

Pharmacy Comments

Contract Details

Approval Date

7/10/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/15/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Chris Hammes, Executive Vice President
(405) 949-3400

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/10/2020

340B Drug Pricing Program Database