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OPTUM PHARMACY 702, LLC
DSH220046 BERKSHIRE MEDICAL CENTER
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Covered Entity Details
Entity Name
BERKSHIRE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220046
Entity Address
725 NORTH STREET
PITTSFIELD, MA 01201
Medicare Provider Number
220046
Participating Start Date
1/1/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DARLENE RODOWICZ, Executive Vice President & Treasurer
(413) 447-2809
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/7/2020
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