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OPTUM PHARMACY 705, LLC
DSH360085 THE OHIO STATE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE OHIO STATE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360085
Entity Address
410 W. 10th Avenue
COLUMBUS, OH 43210
Medicare Provider Number
360085
Participating Start Date
7/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
1/20/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vincent P Tammaro, Chief Financial Officer
(614) 685-9420
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/20/2023
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