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OPTUM INFUSION SERVICES 103, LLC
DSH210003 Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center
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Covered Entity Details
Entity Name
Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210003
Entity Address
901 Harry S. Truman Drive North
Upper Marlboro, MD 20774
Medicare Provider Number
210003
Participating Start Date
4/1/2015
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 103, LLC
Pharmacy Address
9204 BERGER RD.
STE. A
COLUMBIA, MD 21046-1729
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/17/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Min Godwin, Chief Operating Officer
(212) 767-9602
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2022
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