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OPTUM PHARMACY 702, LLC
DSH330193 FLUSHING HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
FLUSHING HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330193
Entity Address
4500 PARSONS BLVD
PARSONS BLVD AND 45TH AVENUE
FLUSHING, NY 11355
Medicare Provider Number
330193
Participating Start Date
10/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/13/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2023
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