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OKLAHOMA CVS PHARMACY, L.L.C.
DSH370094 SSM Health St Anthony Hospital - Midwest
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Covered Entity Details
Entity Name
SSM Health St Anthony Hospital - Midwest
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370094
Entity Address
2825 Parklawn Dr
MIDWEST CITY, OK 73110
Medicare Provider Number
370094
Participating Start Date
4/1/2022
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
OKLAHOMA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05959
900 SW 44TH ST
OKLAHOMA CITY, OK 73109
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2025
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