Contract Pharmacy Details

SINA DRUG LLC
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH470003

Entity Address

111 Colchester Avenue
Burlington, VT 05401

Medicare Provider Number

470003

Participating Start Date

4/1/2005

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

SINA DRUG LLC

Pharmacy Address

DBA ONCO360
1985 MARCUS AVE STE 120
NEW HYDE PARK, NY 11042

Pharmacy Comments

08/02/2012 corrected name (was OncoMed Pharmacy)

Contract Details

Approval Date

10/17/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christina Oliver, VP of Clinical Services
(802) 847-2805

Contract Pharmacy Representative

Onco360
Leo Gray, Director of Pharmacy
(877) 662-6633 Ext: 1207

Signed By Date

10/17/2018

340B Drug Pricing Program Database