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OPTUM PHARMACY 702, LLC
DSH100276 Broward Health Coral Springs
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Covered Entity Details
Entity Name
Broward Health Coral Springs
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100276
Entity Address
3000 CORAL HILLS DRIVE
CORAL SPRINGS, FL 33065
Medicare Provider Number
100276
Participating Start Date
10/1/2007
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Modesto Gato, Chief Financial Officer
(786) 273-6188
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2023
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