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OKLAHOMA CVS PHARMACY, 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
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06021
800 SE 4TH ST
MOORE, OK 73160
Pharmacy Comments
Contract Details
Approval Date
1/6/2023
Contract Begin Date
4/1/2023
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
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842
Contract Pharmacy Representative
CVS
Christian Reed, Sr. Director
(401) 770-2118
Signed By Date
1/6/2023
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