340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 704, INC.
DSH450021 BAYLOR UNIVERSITY MEDICAL CTR
Print
Covered Entity Details
Entity Name
BAYLOR UNIVERSITY MEDICAL CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450021
Entity Address
3500 GASTON AVENUE
DALLAS, TX 75246
Medicare Provider Number
450021
Participating Start Date
3/7/2023
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
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
Kyle Armstrong, President
(214) 820-3101
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session