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SINA DRUG LLC
DSH100093 BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100093
Entity Address
123 Baptist Way
PENSACOLA, FL 32503
Medicare Provider Number
100093
Participating Start Date
4/1/2009
Last Recertification Date
8/28/2024
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
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Nobles, CFO
(850) 469-2315
Contract Pharmacy Representative
Onco360 Oncology Pharmacy
Jim Bozora, VP of 340B Oncology Sales
(702) 281-5985
Signed By Date
7/15/2016
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