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SINA DRUG LLC
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
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
2/14/2012
Contract Begin Date
2/14/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Gross, Chief Financial Officer
(417) 256-9111 Ext: 6010
Contract Pharmacy Representative
Kevin Askari, President
(516) 869-0920 Ext: 1209
Signed By Date
2/1/2012
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