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ONCOMED PHARMACEUTICAL SERVICES OF MA, I
DSH260137K FREEMAN HEALTH SYSTEM
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Covered Entity Details
Entity Name
FREEMAN HEALTH SYSTEM
Subdivision Name
Freeman Cancer Institute Grove
Type
Disproportionate Share Hospital
340B ID
DSH260137K
Entity Address
601 E. 13th Street
Grove, OK 74344
Medicare Provider Number
260137
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
8/6/2015
Entity Termination Date
1/1/2016
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
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Contacts
Covered Entity Signing Official
STEVE GRADDY, CFO
(417) 347-6678
Contract Pharmacy Representative
Burt Zweigenhaft, CEO
(646) 356-7709
Signed By Date
10/14/2014
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