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SAINT FRANCIS WARREN CLINIC TOWER PHARMA
DSH370025 SAINT FRANCIS HOSPITAL MUSKOGEE
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Covered Entity Details
Entity Name
SAINT FRANCIS HOSPITAL MUSKOGEE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370025
Entity Address
300 ROCKEFELLER DRIVE
MUSKOGEE, OK 74401
Medicare Provider Number
370025
Participating Start Date
1/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAINT FRANCIS WARREN CLINIC TOWER PHARMA
Pharmacy Address
SAINT FRANCIS PHARMACY SERVICES, INC
6600 S YALE AVE STE 110
TULSA, OK 74136
Pharmacy Comments
Contract Details
Approval Date
11/23/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2025
Ownership change
Contacts
Covered Entity Signing Official
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418
Contract Pharmacy Representative
Saint Francis Pharmacy Services
Jay Tipps, Director
(918) 502-7350
Signed By Date
10/14/2022
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