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SINA DRUG LLC
DSH100135 TALLAHASSEE MEMORIAL HEALTHCARE, INC
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Covered Entity Details
Entity Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100135
Entity Address
1300 MICCOSUKEE ROAD
TALLAHASSEE, FL 32308
Medicare Provider Number
100135
Participating Start Date
1/1/2005
Last Recertification Date
9/6/2024
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
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Priscilla Needham, Chief Financial Officer
(850) 431-0630
Contract Pharmacy Representative
Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203
Signed By Date
7/13/2023
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