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OPTUM PHARMACY 700, LLC
DSH330055 NEWYORK-PRESBYTERIAN / QUEENS
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Covered Entity Details
Entity Name
NEWYORK-PRESBYTERIAN / QUEENS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330055
Entity Address
56-45 MAIN STREET
FLUSHING, NY 11355
Medicare Provider Number
330055
Participating Start Date
4/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
19 CHAPIN RD BLDG D, STE D8
PINE BROOK, NJ 07058
Pharmacy Comments
Contract Details
Approval Date
10/18/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/18/2021
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