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OPTUM PHARMACY 705, LLC
DSH220031 BOSTON MEDICAL CENTER
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Covered Entity Details
Entity Name
BOSTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220031
Entity Address
1 Boston Medical Center Place
BOSTON, MA 02118
Medicare Provider Number
220031
Participating Start Date
12/1/1992
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
11142 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
7/17/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Kathleen E. Walsh, Chief Executive Officer
(617) 638-6911
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/17/2020
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