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OPTUM PHARMACY 701, LLC
DSH100075 ST JOSEPH'S HOSPITAL
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100075
Entity Address
3001 WEST DR. M L KING JR BLVD
TAMPA, FL 33607
Medicare Provider Number
100075
Participating Start Date
4/1/2003
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
4/23/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/23/2024
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