Contract Pharmacy Details

OPTUM INFUSION SERVICES 500, INC
DSH110034 AU Medical Center, Inc.

Covered Entity Details

Entity Name

AU Medical Center, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110034

Entity Address

1120 15TH ST.
AUGUSTA, GA 30912

Medicare Provider Number

110034

Participating Start Date

12/1/1992

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 500, INC

Pharmacy Address

8400 ESTERS BLVD STE 185
IRVING, TX 75063-2864

Pharmacy Comments

Contract Details

Approval Date

7/3/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jennifer Miller, Chief Strategy Officer
(706) 836-7051

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/3/2024

340B Drug Pricing Program Database