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INTEGRIS PHARMACY 4185
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 4185
Pharmacy Address
4221 S WESTERN AVE STE 1020
OKLAHOMA CITY, OK 73109-3448
Pharmacy Comments
Contract Details
Approval Date
8/27/2013
Contract Begin Date
8/27/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/17/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James D. Moore, President
(405) 636-7690
Contract Pharmacy Representative
INTEGRIS Pro Health
Doug Smith, Executive VP
(405) 951-8204
Signed By Date
7/30/2013
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