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OPTUM INFUSION SERVICES 208, INC.
DSH340091 THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
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Covered Entity Details
Entity Name
THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340091
Entity Address
1200 NORTH ELM STREET
GREENSBORO, NC 27401-1020
Medicare Provider Number
340091
Participating Start Date
4/1/2006
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 208, INC.
Pharmacy Address
556 ARBOR HILL RD STE F
KERNERSVILLE, NC 27284-3321
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew Barrow, Chief Financial Officer
(336) 832-7825
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/11/2021
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