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OPTUM PHARMACY 701, LLC
CHC06642-03 WESTERN MARYLAND HEALTH CARE CORPORATION
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Covered Entity Details
Entity Name
WESTERN MARYLAND HEALTH CARE CORPORATION
Subdivision Name
Mountain Laurel Medical Center Bruceton Mills
Type
HRSA-Funded Health Center
340B ID
CHC06642-03
Entity Address
198 Morgantown St
Ste 2
Bruceton Mills, WV 26525-5003
Grant Number
H80CS06642
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James W. Mou, CFO
(301) 533-3300 Ext: 3018
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2023
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