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OPTUM INFUSION SERVICES 206, INC.
DSH250001 University of Mississippi Medical Center
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Covered Entity Details
Entity Name
University of Mississippi Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250001
Entity Address
2500 NORTH STATE ST.
JACKSON, MS 39216
Medicare Provider Number
250001
Participating Start Date
4/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 206, INC.
Pharmacy Address
1201 MONTLIMAR DRIVE
SUITE 900
MOBILE, AL 36609
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
7/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Grimsley, CFO-Health System
(601) 815-6270
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2021
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