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PROCARE PHARMACY, L.L.C.
DSH370106 INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
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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
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
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
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