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OPTUM PHARMACY 705, LLC
DSH360059 METROHEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
METROHEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360059
Entity Address
2500 MetroHealth Drive
CLEVELAND, OH 44109-1900
Medicare Provider Number
360059
Participating Start Date
1/1/1994
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Stern, SVP, Chief of Staff
(216) 778-5772
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/9/2018
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