Contract Pharmacy Details

RAINA RX LLC
DSH370093 OU MEDICAL CENTER

Covered Entity Details

Entity Name

OU MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370093

Entity Address

700 NE 13TH ST.
OKLAHOMA CITY, OK 73104

Medicare Provider Number

370093

Participating Start Date

7/1/2018

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

RAINA RX LLC

Pharmacy Address

DBA ROUTE 300 PHARMACY
1208 ROUTE 300
SUITE 103
NEWBURGH, NY 12550

Pharmacy Comments

Contract Details

Approval Date

10/13/2020

Contract Begin Date

10/27/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

James Michael Watson, CFO
(405) 271-5100

Contract Pharmacy Representative

BioPlusRx
Joseph Munson, Director of 340B Programs
(843) 494-2915

Signed By Date

10/13/2020

340B Drug Pricing Program Database