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SINA DRUG LLC
DSH240115 MERCY HOSPITAL
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Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240115
Entity Address
4050 COON RAPIDS BLVD
COON RAPIDS, MN 55433
Medicare Provider Number
240115
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SINA DRUG LLC
Pharmacy Address
DBA ONCO360
7125 JANES AVE
STE 700
WOODRIDGE, IL 60517
Pharmacy Comments
Contract Details
Approval Date
10/7/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
Sina Drugs dba Onco 360 Illinois
Kimberely Beranek, Director of Pharmacy
(877) 662-6633 Ext: 2101
Signed By Date
10/7/2022
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