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OPTUM PHARMACY 702, LLC
DSH390097 Holy Redeemer Hospital
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Covered Entity Details
Entity Name
Holy Redeemer Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390097
Entity Address
1648 Huntingdon Pike
Meadowbrook, PA 19046
Medicare Provider Number
390097
Participating Start Date
4/1/2013
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
4/17/2023
Contract Begin Date
5/15/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Keen, EVP and CFO
(215) 856-1114
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/17/2023
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