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OPTUM PHARMACY 705, LLC
DSH060004 Brighton Community Hospital Association DBA: Intermountain Health Platte Valley Hospital
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Covered Entity Details
Entity Name
Brighton Community Hospital Association DBA: Intermountain Health Platte Valley Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060004
Entity Address
1600 PRAIRIE CENTER PKWY.
BRIGHTON, CO 80601
Medicare Provider Number
060004
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
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
Contract Termination Date
Termination Reason
10/27/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Troy Stoehr, VP of Finance
(303) 498-1606
Contract Pharmacy Representative
Optum
McKinnlee Bowman, National Account Manager
(855) 828-9834
Signed By Date
4/18/2022
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