Contract Pharmacy Details

SINA DRUG LLC
DSH260070 PEMISCOT COUNTY MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

PEMISCOT COUNTY MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH260070

Entity Address

946 East Reed
HAYTI, MO 63851

Medicare Provider Number

260070

Participating Start Date

1/1/2015

Last Recertification Date

8/20/2024

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

4/1/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DAVID KETCHUM, CEO
(573) 359-3579

Contract Pharmacy Representative

Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203

Signed By Date

4/1/2024

340B Drug Pricing Program Database