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INTEGRIS PHARMACY 4188
DSH370106 INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
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Covered Entity Details
Entity Name
INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370106
Entity Address
4401 SOUTH WESTERN AVE
OKLAHOMA CITY, OK 73109
Medicare Provider Number
370106
Participating Start Date
7/1/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
INTEGRIS PHARMACY 4188
Pharmacy Address
5915 W. MEMORIAL RD, STE 110
OKLAHOMA CITY, OK 73142
Pharmacy Comments
Contract Details
Approval Date
11/25/2011
Contract Begin Date
11/25/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Hammas, President & Managing Director of IBMC
(405) 949-3400
Contract Pharmacy Representative
INTEGRIS Pro Health
Doug Smith, Executive VP
(405) 951-8204
Signed By Date
11/11/2011
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