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SAINT FRANCIS OUTPATIENT PHARMACY
DSH370025 SAINT FRANCIS HOSPITAL MUSKOGEE
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Covered Entity Details
Entity Name
SAINT FRANCIS HOSPITAL MUSKOGEE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370025
Entity Address
300 ROCKEFELLER DRIVE
MUSKOGEE, OK 74401
Medicare Provider Number
370025
Participating Start Date
1/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SAINT FRANCIS OUTPATIENT PHARMACY
Pharmacy Address
SAINT FRANCIS HOSPITAL, INC
6161 S YALE AVE
B LEVEL BLUE NORTH
TULSA, OK 74136
Pharmacy Comments
Contract Details
Approval Date
4/13/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418
Contract Pharmacy Representative
Saint Francis Health System
David Donald, System Director, Pharmacy
(918) 494-1167
Signed By Date
4/13/2025
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