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SINA DRUG LLC
RRC140179-00 OSF LITTLE COMPANY OF MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
OSF LITTLE COMPANY OF MARY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140179-00
Entity Address
2800 WEST 95TH STREET
EVERGREEN PARK, IL 60805
Medicare Provider Number
140179
Participating Start Date
1/1/2019
Last Recertification Date
8/30/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
SINA DRUG LLC
Pharmacy Address
DBA ONCO360
7125 JANES AVE
STE 700
WOODRIDGE, IL 60517
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
Sina Drugs dba Onco 360 Illinois
Kimberely Beranek, Director of Pharmacy
(877) 662-6633 Ext: 2101
Signed By Date
7/15/2020
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