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INTEGRIS PHARMACY 4173
DSH370016 INTEGRIS HEALTH ENID HOSPITAL
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Covered Entity Details
Entity Name
INTEGRIS HEALTH ENID HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370016
Entity Address
600 S MONROE ST
ENID, OK 73701-7211
Medicare Provider Number
370016
Participating Start Date
10/1/2009
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
INTEGRIS PHARMACY 4173
Pharmacy Address
600 S MONROE ST STE 1A
ENID, OK 73701-7211
Pharmacy Comments
Contract Details
Approval Date
1/21/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edward Herrman, President
(580) 548-1100
Contract Pharmacy Representative
INTEGRIS Pro Health
Doug Smith, Executive VP
(405) 951-8204
Signed By Date
1/21/2016
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