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OPTUM PHARMACY 705, LLC
PED013301-00 USA Health Children's and Women's Hospital
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Covered Entity Details
Entity Name
USA Health Children's and Women's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED013301-00
Entity Address
1700 Center Street
Mobile, AL 36604-3301
Medicare Provider Number
013301
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
1/14/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Traci Jones, CFO
(251) 445-9164
Contract Pharmacy Representative
Optum
Nancy Mccuthcheon, Senior VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2021
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