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OPTUM PHARMACY 700, LLC
DSH220086AE BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
MEDICAL CARE CENTER OF LEXINGTON - OCCUPATIONAL THERAPY SERVICES
Type
Disproportionate Share Hospital
340B ID
DSH220086AE
Entity Address
482 BEDFORD STREET
LEXINGTON, MA 02420
Medicare Provider Number
220086
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew Larkin, Chief Operating Officer
(617) 677-7144
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/21/2023
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