Contract Pharmacy Details

SINA DRUG LLC
FQHCLA225 Maricopa County Special Health Care District

Covered Entity Details

Entity Name

Maricopa County Special Health Care District

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA225

Entity Address

2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008

Grant Number

LALCS00037

Participating Start Date

10/1/2007

Last Recertification Date

2/15/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

SINA DRUG LLC

Pharmacy Address

DBA ONCO360
1985 MARCUS AVE STE 120
NEW HYDE PARK, NY 11042

Pharmacy Comments

08/02/2012 corrected name (was OncoMed Pharmacy)

Contract Details

Approval Date

10/16/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kris Gaw, Chief Operating Officer
(602) 344-1258

Contract Pharmacy Representative

Onco360
Leo Gray, Director of Pharmacy
(877) 662-6633 Ext: 1207

Signed By Date

10/16/2017

340B Drug Pricing Program Database