340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
INTEGRIS PHARMACY 4190
DSH370028 INTEGRIS BAPTIST MEDICAL CENTER
Print
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
INTEGRIS PHARMACY 4190
Pharmacy Address
3433 NW 56TH ST., STE 140B
OKLAHOMA CITY, OK 73112
Pharmacy Comments
2/13/12 UPDATED ADD (WAS 3443 NW 56TH ST)
Contract Details
Approval Date
10/1/2008
Contract Begin Date
10/1/2008
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Chris Hammas, President & Managing Director of IBMC
(405) 949-3400
Contract Pharmacy Representative
WENTZ MILLER, VICE PRESIDENT
(405) 945-4403
Signed By Date
9/3/2008
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session