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ONCOMED PHARMACEUTICAL SERVICES OF MA, L
CAH141318-00 OSF Holy Family Medical Center
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Covered Entity Details
Entity Name
OSF Holy Family Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141318-00
Entity Address
1000 West Harlem Ave
Monmouth, IL 61462
Medicare Provider Number
141318
Participating Start Date
1/1/2013
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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