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ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
DSH140186D RIVERSIDE MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
RIVERSIDE CANCER CENTER
Type
Disproportionate Share Hospital
340B ID
DSH140186D
Entity Address
200 Riverside Drive
Bourbonnais, IL 60914
Medicare Provider Number
140186
Outpatient Facility Provider Number
Participating Start Date
1/1/2007
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
Pharmacy Address
LLC DBA ONCO360
1553 CHESTER PIKE SUITE 206
CRUM LYNNE, PA 19022
Pharmacy Comments
Contract Details
Approval Date
7/8/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patricia K. Vilt, Vice President of Finance
(815) 935-7256
Contract Pharmacy Representative
Burt Zweigenhaft, CEO
(646) 356-7709
Signed By Date
7/8/2013
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