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OPTUMRX
DSH100022 JACKSON HEALTH SYSTEM
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Covered Entity Details
Entity Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH100022
Entity Address
1611 NW 12 AVE.
MIAMI, FL 33136
Medicare Provider Number
100022
Participating Start Date
12/1/1992
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUMRX
Pharmacy Address
OPTUMRX INC
6800 W 115TH ST STE 600
OVERLAND PARK, KS 66211-9838
Pharmacy Comments
Contract Details
Approval Date
1/27/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carlos A. Migoya, CEO
(305) 585-6754
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/27/2025
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