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OPTUM PHARMACY 705, LLC
DSH210029 JOHNS HOPKINS BAYVIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210029
Entity Address
4940 EASTERN AVENUE
BALTIMORE, MD 21224
Medicare Provider Number
210029
Participating Start Date
10/1/2001
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl H Francioli, Vice President, Finance & CFO
(410) 550-0909
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2022
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