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OKLAHOMA CVS PHARMACY, L.L.C.
DSH370091 Saint Francis Hospital
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Covered Entity Details
Entity Name
Saint Francis Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370091
Entity Address
6161 South Yale Avenue
Tulsa, OK 74136
Medicare Provider Number
370091
Participating Start Date
4/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10012
11223 EAST 31ST ST. SOUTH
TULSA, OK 74146
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/7/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2023
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