Contract Pharmacy Details

OPTUM PHARMACY 700, LLC
DSH190054 IBERIA MEDICAL CENTER

Covered Entity Details

Entity Name

IBERIA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH190054

Entity Address

2315 EAST MAIN STREET
NEW IBERIA, LA 70560

Medicare Provider Number

190054

Participating Start Date

7/1/2004

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 700, LLC

Pharmacy Address

5700 DOT COM CT, STE 1000
OVIEDO, FL 32765

Pharmacy Comments

Contract Details

Approval Date

10/14/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dionne E Viator, CFO
(337) 374-7107

Contract Pharmacy Representative

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

Signed By Date

10/14/2020

340B Drug Pricing Program Database