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IgG of America, Inc
DSH370093 OU MEDICAL CENTER
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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
IgG of America, Inc
Pharmacy Address
514 Progress Dr
Suite X
Linthicum, MD 21090
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
10/20/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Michael Watson, CFO
(405) 271-5100
Contract Pharmacy Representative
US Bioservices
Mischelle Smoot, Pharmacist-in-Charge
(888) 518-7246
Signed By Date
10/13/2020
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