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ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
DSH450828 CHRISTUS SPOHN HOSPITAL ALICE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL ALICE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450828
Entity Address
2500 EAST MAIN ST.
ALICE, TX 78332
Medicare Provider Number
450828
Participating Start Date
9/16/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
Pharmacy Address
LLC DBA ONCO360
1553 CHESTER PIKE SUITE 206
CRUM LYNNE, PA 19022
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela L. Brower, Chief Finance Officer
(361) 881-3432
Contract Pharmacy Representative
Tom Corrigan, Pharmacist in Charge
(877) 662-6633 Ext: 1501
Signed By Date
4/13/2015
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