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OPTUM PHARMACY 705, LLC
DSH050485 Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
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Covered Entity Details
Entity Name
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050485
Entity Address
2801 ATLANTIC AVENUE
LONG BEACH, CA 90806
Medicare Provider Number
050485
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/19/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patti Pilgrim, Chief Financial Officer
(562) 933-1905
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/19/2024
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