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OPTUMRX
DSH330024 THE MOUNT SINAI HOSPITAL
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Covered Entity Details
Entity Name
THE MOUNT SINAI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330024
Entity Address
ONE GUSTAVE L. LEVY PLACE
NEW YORK, NY 10029
Medicare Provider Number
330024
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUMRX
Pharmacy Address
2858 LOKER AVE E STE 100
CARLSBAD, CA 92010-6608
Pharmacy Comments
Contract Details
Approval Date
10/8/2020
Contract Begin Date
10/23/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/8/2020
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