Contract Pharmacy Details

OKLAHOMA CVS PHARMACY, L.L.C.
DSH370106 INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

Covered Entity Details

Entity Name

INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370106

Entity Address

4401 SOUTH WESTERN AVE
OKLAHOMA CITY, OK 73109

Medicare Provider Number

370106

Participating Start Date

7/1/2009

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

OKLAHOMA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05959
900 SW 44TH ST
OKLAHOMA CITY, OK 73109

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/15/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Chris Hammes, Executive Vice President
(405) 949-3400

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2020

340B Drug Pricing Program Database