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WALGREEN CO.
DSH370016 INTEGRIS HEALTH ENID HOSPITAL
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Covered Entity Details
Entity Name
INTEGRIS HEALTH ENID HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370016
Entity Address
600 S MONROE ST
ENID, OK 73701-7211
Medicare Provider Number
370016
Participating Start Date
10/1/2009
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16556
1611 E. 15TH ST.
TULSA, OK 74120
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
4/13/2023
Covered Entity Terminated
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
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