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OPTUM PHARMACY 705, LLC
DSH490032 Virginia Commonwealth University Health System
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Covered Entity Details
Entity Name
Virginia Commonwealth University Health System
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490032
Entity Address
1250 East Marshall Street
RICHMOND, VA 23298
Medicare Provider Number
490032
Participating Start Date
12/1/1992
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/16/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Wesolowski, Chief Operating Officer
(804) 828-4607
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/16/2022
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