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SINA DRUG LLC
DSH230021 LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
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Covered Entity Details
Entity Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
Subdivision Name
LAKELAND HOSPITAL - ST JOSEPH
Type
Disproportionate Share Hospital
340B ID
DSH230021
Entity Address
1234 NAPIER AVENUE
ST JOSEPH, MI 49085
Medicare Provider Number
230021
Participating Start Date
10/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
SINA DRUG LLC
Pharmacy Address
D/B/A ONCO 360
13410 EASTPOINT CENTRE DR
STE 101
LOUISVILLE, KY 40223
Pharmacy Comments
Contract Details
Approval Date
10/20/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Vincent Konopacki, VP Finance & CFO
(269) 313-7188 Ext: 2693137188
Contract Pharmacy Representative
Onco360 Oncology Pharmacy
Jim Bozora, VP of 340B Oncology Sales
(702) 281-5985
Signed By Date
10/20/2021
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