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SINA DRUG LLC
DSH330180 SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330180
Entity Address
2215 BURDETT AVE
TROY, NY 12180
Medicare Provider Number
330180
Participating Start Date
1/1/2019
Last Recertification Date
8/27/2024
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
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203
Signed By Date
1/12/2022
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