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OPTUM PHARMACY 705, LLC
DSH070028 ST. VINCENTS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. VINCENTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070028
Entity Address
2800 MAIN STREET
BRIDGEPORT, CT 06606-4201
Medicare Provider Number
070028
Participating Start Date
1/13/2023
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
1/13/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Given, VP, Finance
(475) 210-6193
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/8/2023
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