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OPTUM PHARMACY 705, LLC
DSH380007 LEGACY EMANUEL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380007
Entity Address
2801 N GANTENBEIN AVE
PORTLAND, OR 97227
Medicare Provider Number
380007
Participating Start Date
7/1/2007
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Majid Tanas, VP Pharmacy Services
(503) 415-5011
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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