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OPTUM PHARMACY 705, LLC
DSH450046 CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450046
Entity Address
600 Elizabeth St.
CORPUS CHRISTI, TX 78404
Medicare Provider Number
450046
Participating Start Date
4/1/1997
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
6/10/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Becky Rios, CFO
(361) 881-3157
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2020
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