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OPTUM INFUSION SERVICES 202, INC.
DSH100088 BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100088
Entity Address
800 PRUDENTIAL DRIVE
JACKSONVILLE, FL 32207
Medicare Provider Number
100088
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 202, INC.
Pharmacy Address
9655 FLORIDA MINING BLVD W
STE 411
JACKSONVILLE, FL 32257-2041
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott M. Wooten, SVP & CFO
(904) 202-3405
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/9/2021
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