340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Print
Covered Entity Details
Entity Name
Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340053
Entity Address
200 HAWTHORNE LANE
CHARLOTTE, NC 28204
Medicare Provider Number
340053
Participating Start Date
4/1/2008
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca A Bean, SVP Chief Pharmacy Executive
(336) 277-5862
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/12/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session