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OPTUM PHARMACY 702, LLC
DSH390142 ALBERT EINSTEIN MEDICAL CENTER
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Covered Entity Details
Entity Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390142
Entity Address
5501 OLD YORK ROAD
PHILADELPHIA, PA 19141
Medicare Provider Number
390142
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/6/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GERARD BLANEY, CHIEF FINANCIAL OFFICER
(215) 456-6020
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/6/2017
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