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ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
DSH390086 DUBOIS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
dba Penn Highlands DuBois
Type
Disproportionate Share Hospital
340B ID
DSH390086
Entity Address
100 HOSPITAL AVENUE
DUBOIS, PA 15801
Medicare Provider Number
390086
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
Pharmacy Address
D/B/A ONCO360
140 JOHN JAMES AUDUBON PKWY STE 101
AMHERST, NY 14228
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Kline, CFO
(814) 375-6377
Contract Pharmacy Representative
Onco360
Eric Smith, Director of Pharmacy
(877) 662-6633 Ext: 1602
Signed By Date
1/15/2019
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