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OPTUM INFUSION SERVICES 500, INC.
DSH310086 KENNEDY MEMORIAL HOSPITAL-UMC
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Covered Entity Details
Entity Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310086
Entity Address
18 East Laurel Road
Stratford, NJ 08084
Medicare Provider Number
310086
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
19 CHAPIN RD BLDG D
SUITE D7
PINE BROOK, NJ 07058-9385
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
8/3/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
John W Graham, VP - Chief Administrative Officer
(856) 582-2661
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2021
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