Contract Pharmacy Details

OPTUM PHARMACY 801, INC.
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)

Covered Entity Details

Entity Name

CHARLESTON AREA MEDICAL CENTER (CAMC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510022

Entity Address

501 MORRIS STREET
CHARLESTON, WV 25301

Medicare Provider Number

510022

Participating Start Date

9/22/2005

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 801, INC.

Pharmacy Address

24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085

Pharmacy Comments

Contract Details

Approval Date

7/2/2020

Contract Begin Date

7/2/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

STEPHEN BELL, VICE PRESIDENT - FINANCE
(304) 388-6251

Contract Pharmacy Representative

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

Signed By Date

7/2/2020

340B Drug Pricing Program Database