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OPTUM PHARMACY 702, LLC
DSH190005 University Medical Center Management Corporation d/b/a University Medical Center New Orleans
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Covered Entity Details
Entity Name
University Medical Center Management Corporation d/b/a University Medical Center New Orleans
Subdivision Name
UMCNO
Type
Disproportionate Share Hospital
340B ID
DSH190005
Entity Address
2000 Canal Street
NEW ORLEANS, LA 70112
Medicare Provider Number
190005
Participating Start Date
1/1/1997
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Miranda, Chief Operating Officer
(504) 702-4411
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2022
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