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SINA DRUG LLC
DSH130049 KOOTENAI HEALTH INC
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Covered Entity Details
Entity Name
KOOTENAI HEALTH INC
Subdivision Name
KOOTENAI HEALTH
Type
Disproportionate Share Hospital
340B ID
DSH130049
Entity Address
2003 Kootenai Health Way
COEUR DALENE, ID 83814
Medicare Provider Number
130049
Participating Start Date
7/1/2021
Last Recertification Date
8/20/2024
Entity Termination Date
7/1/2025
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
4/11/2023
Contract Begin Date
5/10/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michele Bouit, CFO
(208) 625-4004
Contract Pharmacy Representative
Onco360
Sara Hess, Director of Pharmacy
(877) 662-6633 Ext: 1706
Signed By Date
4/11/2023
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