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OPTUM PHARMACY 705, LLC
DSH450236 CHRISTUS Mother Frances Hospital-Sulphur Springs - CHRISTUS Hopkins Health Alliance
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Covered Entity Details
Entity Name
CHRISTUS Mother Frances Hospital-Sulphur Springs - CHRISTUS Hopkins Health Alliance
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450236
Entity Address
115 AIRPORT ROAD
SULPHUR SPRINGS, TX 75482
Medicare Provider Number
450236
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
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
6/8/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Harvey, CEO
(903) 439-4052
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2020
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