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ONCOMED PHARMACEUTICAL SERVICES OF MA, L
DSH520136 Ascension SE Wisconsin Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
ST. JOSEPH CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH520136
Entity Address
5000 WEST CHAMBERS STREET
MILWAUKEE, WI 53210
Medicare Provider Number
520136
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ONCOMED PHARMACEUTICAL SERVICES OF MA, L
Pharmacy Address
D/B/A ONCO360
335 BEAR HILL RD
STE 2100
WALTHAM, MA 02451
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183
Contract Pharmacy Representative
OncoMed Pharmaceutical
Mina Saied, Director of Pharmacy
(877) 662-6633 Ext: 1320
Signed By Date
1/12/2018
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