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OPTUM INFUSION SERVICES 101, INC.
DSH330056 THE BROOKLYN HOSPITAL CENTER
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Covered Entity Details
Entity Name
THE BROOKLYN HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330056
Entity Address
121 DEKALB AVE
BROOKLYN, NY 11201
Medicare Provider Number
330056
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 101, INC.
Pharmacy Address
931 CONKLIN ST STE D
FARMINGDALE, NY 11735-2429
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
4/22/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald P. Minarcik, VP Revenue Enhancement
(718) 488-3775
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2021
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