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OPTUM PHARMACY 702, LLC
DSH070016 Saint Mary's Hospital
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Covered Entity Details
Entity Name
Saint Mary's Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070016
Entity Address
56 Franklin Street
Waterbury, CT 06706
Medicare Provider Number
070016
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/16/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris M Hayes, VP of Finance
(203) 709-6294
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/16/2020
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