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OPTUM PHARMACY 701, LLC
DSH340099 East Carolina Health d/b/a ECU Health Roanoke-Chowan Hospital
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Covered Entity Details
Entity Name
East Carolina Health d/b/a ECU Health Roanoke-Chowan Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340099
Entity Address
500 SOUTH ACADEMY ST
AHOSKIE, NC 27910
Medicare Provider Number
340099
Participating Start Date
7/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Alford, Vice President, Financial Services
(252) 641-7131
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2023
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