Contract Pharmacy Details

WALGREEN CO.
DSH370093 OU MEDICAL CENTER

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11095
5901 NW 122ND ST.
OKLAHOMA CITY, OK 73142

Pharmacy Comments

Contract Details

Approval Date

4/18/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

James Michael Watson, CFO
(405) 271-5100

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/18/2018

340B Drug Pricing Program Database