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ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
DSH140276Z LOYOLA UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
LOYOLA CANCER CARE & RESEARCH AT THE MARJORIE G. WEINBERG CANCER CENTER AT MELROSE PARK
Type
Disproportionate Share Hospital
340B ID
DSH140276Z
Entity Address
715 WEST NORTH AVENUE
MELROSE PARK, IL 60160
Medicare Provider Number
140276
Outpatient Facility Provider Number
Participating Start Date
7/1/2011
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
Pharmacy Address
LLC DBA ONCO360
1553 CHESTER PIKE SUITE 206
CRUM LYNNE, PA 19022
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
5/15/2018
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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