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OPTUM PHARMACY 705, LLC
PED103300-00 JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.
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Covered Entity Details
Entity Name
JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.
Subdivision Name
Type
Children's Hospital
340B ID
PED103300-00
Entity Address
501 6th Ave. South
St. Petersburg, FL 33701
Medicare Provider Number
103300
Participating Start Date
9/30/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristy Alicia Kim Schulhof, President
(317) 775-3507
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2023
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