Contract Pharmacy Details

OKLAHOMA CVS PHARMACY, L.L.C.
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

OKLAHOMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08314
1040 SW 19TH ST.
MOORE, OK 73160

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

11/14/2022
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database