Contract Pharmacy Details

ONCO360
DSH260137K FREEMAN HEALTH SYSTEM

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

ONCO360

Pharmacy Address

4041 HADLEY ROAD
SOUTH PLAINFIELD, NJ 07080

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