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OPTUM PHARMACY 700, LLC
DSH010029 EAST ALABAMA MEDICAL CENTER
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Covered Entity Details
Entity Name
EAST ALABAMA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010029
Entity Address
2000 PEPPERELL PARKWAY
OPELIKA, AL 36801-5422
Medicare Provider Number
010029
Participating Start Date
10/1/2004
Last Recertification Date
8/12/2024
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
4/13/2021
Contract Begin Date
4/20/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SAM PRICE, CFO
(334) 528-1313
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2021
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