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OPTUM PHARMACY 701, LLC
CAH341327-00 J ARTHUR DOSHER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
J ARTHUR DOSHER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341327-00
Entity Address
924 N HOWE ST
SOUTHPORT, NC 28461
Medicare Provider Number
341327
Participating Start Date
7/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KELLIE VELEZ, CONTROLLER
(910) 457-3815
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2022
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