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ONCOMED PHARMACEUTICAL SERVICES OF MA, I
DSH140276 LOYOLA UNIVERSITY MEDICAL CENTER
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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
ONCOMED PHARMACEUTICAL SERVICES OF MA, I
Pharmacy Address
ONCOMED
150 BEAR HILL ROAD
WALTHAM, MA 02451
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
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