Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
DSH330013 ALBANY MEDICAL CENTER HOSPITAL

Covered Entity Details

Entity Name

ALBANY MEDICAL CENTER HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330013

Entity Address

43 NEW SCOTLAND AVENUE
ALBANY, NY 12208

Medicare Provider Number

330013

Participating Start Date

4/1/2006

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

7/28/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FERDINAND J. VENDITTI, EXECUTIVE VP FOR SYSTEM CARE DELIVERY
(518) 262-5376

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/15/2021

340B Drug Pricing Program Database