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OPTUM PHARMACY 706, INC.
DSH220035 NORTH SHORE MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SHORE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220035
Entity Address
81 HIGHLAND AVENUE
SALEM, MA 01970
Medicare Provider Number
220035
Participating Start Date
9/5/2008
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 706, INC.
Pharmacy Address
30-30 47TH AVENUE
SUITE 410
LONG ISLAND CITY, NY 11101
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
Charles E Adams, Executive Director, Finance
(978) 354-4000
Contract Pharmacy Representative
North Shore Medical Center
Ralph Michael McHatton, Director Pharmacy
(978) 354-2358
Signed By Date
10/12/2023
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