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ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
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
ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO
Pharmacy Address
D/B/A ONCO360
140 JOHN JAMES AUDUBON PKWY STE 101
AMHERST, NY 14228
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Thompson, CFO
(417) 256-9111 Ext: 6031
Contract Pharmacy Representative
Burt Zweigenhaft, CEO
(646) 356-7709
Signed By Date
9/20/2012
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