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SINA DRUG LLC
DSH140224 PRESENCE SAINT JOSEPH HOSP-CHICAGO
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Covered Entity Details
Entity Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140224
Entity Address
2900 NORTH LAKE SHORE DRIVE
CHICAGO, IL 60657
Medicare Provider Number
140224
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
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
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Flavio Marin, CFO
(847) 316-4190
Contract Pharmacy Representative
Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203
Signed By Date
4/6/2021
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