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OPTUM PHARMACY 701, LLC
DSH330169 MOUNT SINAI BETH ISRAEL
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Covered Entity Details
Entity Name
MOUNT SINAI BETH ISRAEL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330169
Entity Address
FIRST AVENUE AT 16TH STREET
NEW YORK, NY 10003
Medicare Provider Number
330169
Participating Start Date
7/1/2005
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Pastier, Senior VP/CFO - The Mount Sinai Hospital
(212) 731-3149
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/1/2024
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