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ONCO360
DSH110007 PHOEBE PUTNEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110007
Entity Address
417 WEST THIRD AVENUE
ALBANY, GA 31701
Medicare Provider Number
110007
Participating Start Date
10/1/2003
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
ONCO360
Pharmacy Address
SINA DRUG, LLC
4700 W SAM HOUSTON PKWY N
STE 150
HOUSTON, TX 77041
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Church, CFO & CAO
(229) 312-4066
Contract Pharmacy Representative
Sina Drugs
shauna barron, Director of Pharmacy
(877) 662-6633 Ext: 2001
Signed By Date
4/15/2020
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