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OPTUM PHARMACY 705, LLC
DSH390329 EINSTEIN MEDICAL CENTER MONTGOMERY
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Covered Entity Details
Entity Name
EINSTEIN MEDICAL CENTER MONTGOMERY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390329
Entity Address
559 WEST GERMANTOWN PIKE
EAST NORRITON, PA 19403
Medicare Provider Number
390329
Participating Start Date
7/1/2016
Last Recertification Date
8/20/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CARRIE FREY, Director of Finance
(215) 612-4313
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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