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OPTUM PHARMACY 702, LLC
DSH340040 PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340040
Entity Address
2100 STANTONSBURG RD
GREENVILLE, NC 27834
Medicare Provider Number
340040
Participating Start Date
4/1/2003
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Floyd, PRESIDENT
(252) 847-5949
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/19/2021
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