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OPTUM PHARMACY 705, LLC
DSH310040 HOBOKEN UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
HOBOKEN UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310040
Entity Address
308 WILLOW AVENUE
HOBOKEN, NJ 07030
Medicare Provider Number
310040
Participating Start Date
4/1/2024
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
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Hughes, Chief Pharmacy Officer
(401) 249-1963
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/15/2024
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