340B Drug Pricing Program Database
OPTUM PHARMACY 701, LLC
DSH220033BU BEVERLY HOSPITAL - information as of 4/29/2025 2:13:05 AM
Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
Danvers Geriatrics - Gerontology
Type
Disproportionate Share Hospital
340B ID
DSH220033BU
Entity Address
480 Maple Street
104
Danvers, MA 01923
Medicare Provider Number
220033
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tom Sands, President
(978) 816-2580
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/18/2023
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