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OPTUM PHARMACY 701, LLC
DSH420019 MUSC HEALTH CHESTER MEDICAL CENTER
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Covered Entity Details
Entity Name
MUSC HEALTH CHESTER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420019
Entity Address
ONE MEDICAL PARK DRIVE
CHESTER, SC 29706
Medicare Provider Number
420019
Participating Start Date
4/1/2024
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
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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