Contract Pharmacy Details

ONCO360
DSH140276 LOYOLA UNIVERSITY MEDICAL CENTER

Covered Entity Details

Entity Name

LOYOLA UNIVERSITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140276

Entity Address

2160 SOUTH FIRST AVENUE
MAYWOOD, IL 60153

Medicare Provider Number

140276

Participating Start Date

4/1/2010

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

ONCO360

Pharmacy Address

4041 HADLEY ROAD
SOUTH PLAINFIELD, NJ 07080

Pharmacy Comments

Contract Details

Approval Date

4/20/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Daniel Post, Executive Vice President
(708) 216-1670

Contract Pharmacy Representative

Kevin C. Ellsworth, Chief Financial Officer
(502) 416-1483

Signed By Date

4/20/2014

340B Drug Pricing Program Database