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OPTUM PHARMACY 801, INC.
DSH210009 JOHNS HOPKINS HOSPITAL
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Covered Entity Details
Entity Name
JOHNS HOPKINS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210009
Entity Address
600 NORTH WOLFE STREET
BALTIMORE, MD 21287
Medicare Provider Number
210009
Participating Start Date
7/1/2002
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katina Williams, VP CFO
(410) 502-5388
Contract Pharmacy Representative
The Johns Hopkins Hospital
Shirley Geize, Assistant Director, Purchasing and Contracting for Pharmacy
(410) 955-0382
Signed By Date
4/12/2022
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