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ONCOMED THE ONCOLOGY PHARMACY OF PHILADE
DSH450801 CHRISTUS ST MICHAEL
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Covered Entity Details
Entity Name
CHRISTUS ST MICHAEL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450801
Entity Address
2600 ST MICHAEL DRIVE
TEXARKANA, TX 75503
Medicare Provider Number
450801
Participating Start Date
4/1/2015
Last Recertification Date
8/14/2024
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
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christopher Karam, President & CEO
(903) 614-2001
Contract Pharmacy Representative
Tom Corrigan, Pharmacist in Charge
(877) 662-6633 Ext: 1501
Signed By Date
4/14/2015
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