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OPTUM INFUSION SERVICES 553, LLC
DSH010087 USA Health University Hospital
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Covered Entity Details
Entity Name
USA Health University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010087
Entity Address
2451 University Hospital Drive
MOBILE, AL 36617
Medicare Provider Number
010087
Participating Start Date
10/1/2003
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 553, LLC
Pharmacy Address
6531 MERIDIEN DR
SUITE 113
RALEIGH, NC 27616
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benny J Stover, USA Health, CFO
(251) 445-9164
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/13/2025
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