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OPTUM PHARMACY 701, LLC
CAH341327-00 J ARTHUR DOSHER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
J ARTHUR DOSHER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341327-00
Entity Address
924 N HOWE ST
SOUTHPORT, NC 28461
Medicare Provider Number
341327
Participating Start Date
7/1/2011
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
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KELLIE VELEZ, CONTROLLER
(910) 457-3815
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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