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OPTUM PHARMACY 705, LLC
DSH010120 MONROE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
MONROE COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010120
Entity Address
2016 S Alabama Ave
MONROEVILLE, AL 36460
Medicare Provider Number
010120
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brandon Nelson, Director of Pharmacy
(251) 743-7413
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/16/2024
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