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OU CHILDREN'S PHARMACY
DSH370093 OU MEDICAL CENTER
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Covered Entity Details
Entity Name
OU MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370093
Entity Address
700 NE 13TH ST.
OKLAHOMA CITY, OK 73104
Medicare Provider Number
370093
Participating Start Date
7/1/2018
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OU CHILDREN'S PHARMACY
Pharmacy Address
BD OF REGENTS OF THE UNIV. OF OKLAHOMA
1200 CHILDRENS AVE STE 2A
OKLAHOMA CITY, OK 73104-4637
Pharmacy Comments
Contract Details
Approval Date
4/18/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2021
Ownership change
Contacts
Covered Entity Signing Official
James Michael Watson, CFO
(405) 271-5100
Contract Pharmacy Representative
OUHSC
Jill Shadid, Director of Pharmacy
(405) 271-6878 Ext: 47823
Signed By Date
4/18/2018
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