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OPTUM INFUSION SERVICES 203 INC
DSH100281 MEMORIAL HOSPITAL WEST
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100281
Entity Address
703 NORTH FLAMINGO ROAD
PEMBROKE PINES, FL 33028
Medicare Provider Number
100281
Participating Start Date
10/11/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 203 INC
Pharmacy Address
9984 PREMIER PKWY
MIRAMAR, FL 33025-3209
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vedner Guerrier, CEO
(954) 538-4810
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/18/2022
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