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OPTUM PHARMACY 702, LLC
DSH100086 BROWARD HEALTH NORTH
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Covered Entity Details
Entity Name
BROWARD HEALTH NORTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100086
Entity Address
201 EAST SAMPLE ROAD
DEERFIELD BEACH, FL 33064
Medicare Provider Number
100086
Participating Start Date
7/1/2022
Last Recertification Date
8/22/2024
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
Contacts
Covered Entity Signing Official
Ivory Jan Monroe, Interim CFO
(954) 297-9049
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2023
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