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OPTUM PHARMACY 700, LLC
DSH330214 NYU Langone Hospitals
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Covered Entity Details
Entity Name
NYU Langone Hospitals
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330214
Entity Address
550 FIRST AVENUE
NEW YORK, NY 10016
Medicare Provider Number
330214
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
19 CHAPIN RD BLDG D, STE D8
PINE BROOK, NJ 07058
Pharmacy Comments
Contract Details
Approval Date
3/10/2021
Contract Begin Date
3/10/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel J Widawsky, Chief Financial Officer
(212) 263-3092
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
3/10/2021
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