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ACARIAHEALTH PHARMACY #26, INC
DSH370093 OU MEDICAL CENTER
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Covered Entity Details
Entity Name
OU MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370093
Entity Address
700 NE 13TH ST.
OKLAHOMA CITY, OK 73104
Medicare Provider Number
370093
Participating Start Date
7/1/2018
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #26, INC
Pharmacy Address
8715 HENDERSON RD
TAMPA, FL 33634
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/28/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Krystal L Murer, Vice President | Ethics, Regulatory Affairs, and Chief Compliance Officer
(405) 271-8052
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
4/15/2024
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