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SAMARITAN INFUSION SERVICES
DSH370211 INTEGRIS CANADIAN VALLEY HOSPITAL
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Covered Entity Details
Entity Name
INTEGRIS CANADIAN VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370211
Entity Address
1201 HEALTH CARE PARKWAY
YUKON, OK 73099
Medicare Provider Number
370211
Participating Start Date
4/1/2023
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SAMARITAN INFUSION SERVICES
Pharmacy Address
3500 N W 56TH, SUITE 201
OKLAHOMA CITY, OK 73112
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rex P. Van Meter, COO
(405) 717-7963
Contract Pharmacy Representative
INTEGRIS Health
Georg F. Lunday, Chief Pharmacy Officer
(405) 401-4842
Signed By Date
10/14/2014
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