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ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
DSH320002K ST. VINCENT HOSPITAL
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Covered Entity Details
Entity Name
ST. VINCENT HOSPITAL
Subdivision Name
Regional Cancer Center - Medical Oncology
Type
Disproportionate Share Hospital
340B ID
DSH320002K
Entity Address
490 A West Zia Road
Santa Fe, NM 87505
Medicare Provider Number
320002
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
8/23/2024
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
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Bruce Tassin, CEO
(505) 913-5201
Contract Pharmacy Representative
Burt Zweigenhaft, CEO
(646) 356-7709
Signed By Date
7/14/2014
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