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OPTUM PHARMACY 702, LLC
DSH420036 MUSC Health Lancaster Medical Center
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Covered Entity Details
Entity Name
MUSC Health Lancaster Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420036
Entity Address
800 WEST MEETING STREET
LANCASTER, SC 29720
Medicare Provider Number
420036
Participating Start Date
1/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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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