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OPTUM PHARMACY 705, LLC
DSH220116 TUFTS MEDICAL CENTER
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Covered Entity Details
Entity Name
TUFTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220116
Entity Address
800 WASHINGTON STREET
BOSTON, MA 02111
Medicare Provider Number
220116
Participating Start Date
10/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
3539 BLUECUTT RD
COLUMBUS, MS 39705
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
2/8/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Assad Siddiqi, Senior Vice President of Finance
(617) 636-7767
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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