Contract Pharmacy Details

OPTUMRX
DSH200009 MAINEHEALTH MAINE MEDICAL CENTER

Covered Entity Details

Entity Name

MAINEHEALTH MAINE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200009

Entity Address

22 BRAMHALL STREET
PORTLAND, ME 04102

Medicare Provider Number

200009

Participating Start Date

7/1/2011

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

OPTUMRX

Pharmacy Address

2858 LOKER AVE E STE 100
CARLSBAD, CA 92010-6608

Pharmacy Comments

Contract Details

Approval Date

4/22/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/27/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Lugene Anthony Inzana, CFO
(207) 662-2654

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/22/2020

340B Drug Pricing Program Database