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OPTUM INFUSION SERVICES 101, INC.
RW410422 North Shore University Hospital
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Covered Entity Details
Entity Name
North Shore University Hospital
Subdivision Name
Type
Ryan White Part D
340B ID
RW410422
Entity Address
865 Northern Blvd
Ste 101
Great Neck, NY 11021
Grant Number
H12HA24869
Participating Start Date
12/15/2011
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 101, INC.
Pharmacy Address
931 CONKLIN ST STE D
FARMINGDALE, NY 11735-2429
Pharmacy Comments
Contract Details
Approval Date
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele L Cusack, Executive Vice President
(516) 321-6058
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/7/2023
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