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OPTUM PHARMACY 705, LLC
DSH490052 RIVERSIDE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490052
Entity Address
500 J Clyde Morris Blvd
NEWPORT NEWS, VA 23601
Medicare Provider Number
490052
Participating Start Date
7/1/2008
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
4/12/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/8/2021
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