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ONCOMED PHARMACEUTICAL SERVICES OF MA, L
DSH140067 SAINT FRANCIS MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140067
Entity Address
530 NE GLEN OAK AVENUE
PEORIA, IL 61637
Medicare Provider Number
140067
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ONCOMED PHARMACEUTICAL SERVICES OF MA, L
Pharmacy Address
D/B/A ONCO360
335 BEAR HILL RD
STE 2100
WALTHAM, MA 02451
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/7/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
OncoMed Pharmaceutical
Mina Saied, Director of Pharmacy
(877) 662-6633 Ext: 1320
Signed By Date
7/15/2020
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