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OPTUM INFUSION SERVICES 200, INC
DSH420091 MUSC Health Florence Medical Center
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Covered Entity Details
Entity Name
MUSC Health Florence Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420091
Entity Address
805 PAMPLICO HIGHWAY
FLORENCE, SC 29505
Medicare Provider Number
420091
Participating Start Date
1/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 200, INC
Pharmacy Address
5895 CORE RD
STE 417
NORTH CHARLESTON, SC 29406
Pharmacy Comments
Contract Details
Approval Date
1/16/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/16/2025
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