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ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
DSH260017 PHELPS COUNTY REGIONAL MEDICAL CNTR
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Covered Entity Details
Entity Name
PHELPS COUNTY REGIONAL MEDICAL CNTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260017
Entity Address
1000 WEST 10TH STREET
ROLLA, MO 65401
Medicare Provider Number
260017
Participating Start Date
3/2/2021
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
Pharmacy Address
D/B/A ONCO360
140 JOHN JAMES AUDUBON PKWY STE 101
AMHERST, NY 14228
Pharmacy Comments
Contract Details
Approval Date
3/4/2021
Contract Begin Date
3/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jana Cook, Chief Financial Officer
(573) 458-7916
Contract Pharmacy Representative
Onco360
Eric Smith, Director of Pharmacy
(877) 662-6633 Ext: 1602
Signed By Date
3/4/2021
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