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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
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
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
10/27/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Michael Watson, CFO
(405) 271-5100
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2020
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