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OPTUM PHARMACY 701, LLC
DSH320021 PRESBYTERIAN HOSPITAL
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Covered Entity Details
Entity Name
PRESBYTERIAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH320021
Entity Address
1100 CENTRAL AVENUE SE
ALBUQUERQUE, NM 87106
Medicare Provider Number
320021
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994
Contract Pharmacy Representative
Optum
Nancy Mccutcheon, SR. VP of Strategic Sales
(651) 983-0677
Signed By Date
1/4/2024
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