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OPTUM PHARMACY 701, LLC
DSH410009 KENT COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KENT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410009
Entity Address
455 TOLL GATE ROAD
WARWICK, RI 02886
Medicare Provider Number
410009
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Burke, VP Finance
(401) 737-7010 Ext: 31154
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/16/2024
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