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SINA DRUG LLC
CAH141325-00 OSF Saint Luke Medical Center
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Covered Entity Details
Entity Name
OSF Saint Luke Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141325-00
Entity Address
1051 WEST SOUTH STREET
KEWANEE, IL 61443
Medicare Provider Number
141325
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
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
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203
Signed By Date
7/15/2020
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