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OPTUM PHARMACY 702, LLC
DSH310038 ROBERT WOOD JOHNSON UNIVERSITY HOSP
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Covered Entity Details
Entity Name
ROBERT WOOD JOHNSON UNIVERSITY HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310038
Entity Address
ONE ROBERT WOOD JOHNSON PLACE
NEW BRUNSWICK, NJ 08901-2601
Medicare Provider Number
310038
Participating Start Date
7/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Alexander, Vice President, Finance
(732) 418-8064
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/15/2019
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