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PROCARE PHARMACY DIRECT, L.L.C.
DSH370028 INTEGRIS BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
INTEGRIS BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370028
Entity Address
3300 NW EXPRESSWAY
OKLAHOMA CITY, OK 73112
Medicare Provider Number
370028
Participating Start Date
1/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
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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