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 # 03883
9000 S. MAY AVE.
OKLAHOMA CITY, OK 73159

Pharmacy Comments

Contract Details

Approval Date

4/15/2022

Contract Begin Date

7/1/2022

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

4/15/2022

340B Drug Pricing Program Database