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OPTUM PHARMACY 702, LLC
DSH210015 FRANKLIN SQUARE HOSPITAL
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Covered Entity Details
Entity Name
FRANKLIN SQUARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210015
Entity Address
9000 FRANKLIN SQUARE DR
BALTIMORE, MD 21237
Medicare Provider Number
210015
Participating Start Date
4/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
1/21/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert P. Lally Jr., CFO
(443) 777-7257
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/18/2022
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