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SINA DRUG LLC
DSH230081 MUNSON HEALTHCARE CADILLAC HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CADILLAC HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230081
Entity Address
400 HOBART ST
CADILLAC, MI 49601
Medicare Provider Number
230081
Participating Start Date
4/1/2022
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen M LaRaia, Vice President
(231) 392-8410
Contract Pharmacy Representative
Onco360 Oncology Pharmacy
Jim Bozora, VP of 340B Oncology Sales
(702) 281-5985
Signed By Date
4/17/2023
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