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OPTUM PHARMACY 702, LLC
DSH340061 UNC Hospitals
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Covered Entity Details
Entity Name
UNC Hospitals
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340061
Entity Address
101 MANNING DR.
CHAPEL HILL, NC 27514
Medicare Provider Number
340061
Participating Start Date
12/1/1992
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin Rowell Daniels, Chief Operating Officer
(984) 974-7744
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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