340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 705, LLC
DSH500077 PROVIDENCE HEALTH & SERVICES-WASHINGTON
Print
Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Subdivision Name
PROVIDENCE HOLY FAMILY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500077
Entity Address
5633 NORTH LIDGERWOOD STREET
SPOKANE, WA 99208
Medicare Provider Number
500077
Participating Start Date
7/1/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Helen Andrus, CFO
(509) 474-3307
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/3/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session