Contract Pharmacy Details

SINA DRUG LLC
DSH140018 MOUNT SINAI HOSPITAL MEDICAL CENTER

Covered Entity Details

Entity Name

MOUNT SINAI HOSPITAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140018

Entity Address

2750 W 15TH PLACE
CHICAGO, IL 60608-1797

Medicare Provider Number

140018

Participating Start Date

10/1/2004

Last Recertification Date

9/6/2024

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

3/15/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

CHARLES WEIS, EXECUTIVE VP & CFO
(773) 257-6642

Contract Pharmacy Representative

Burt Zweigenhaft, CEO
(646) 356-7709

Signed By Date

1/14/2013

340B Drug Pricing Program Database