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OPTUM PHARMACY 702, LLC
DSH100230 MEMORIAL HOSPITAL PEMBROKE
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL PEMBROKE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100230
Entity Address
7800 SHERIDAN STREET
PEMBROKE PINES, FL 33024
Medicare Provider Number
100230
Participating Start Date
1/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen L Demers, CEO
(954) 538-4800
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/17/2022
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