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SINA DRUG LLC
DSH110122 SOUTH GEORGIA MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110122
Entity Address
2501 NORTH PATTERSON STREET
VALDOSTA, GA 31602
Medicare Provider Number
110122
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
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
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald E Dean, CEO
(229) 259-4102
Contract Pharmacy Representative
Onco360
Christopher Choi, Director of Pharmacy
(877) 662-6633 Ext: 1203
Signed By Date
10/7/2024
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