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OPTUM PHARMACY 705, LLC
DSH310016 CHRIST HOSPITAL
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Covered Entity Details
Entity Name
CHRIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310016
Entity Address
176 PALISADES AVENUE
JERSEY CITY, NJ 07306
Medicare Provider Number
310016
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Murdock-Ridley, VP of Finance, CFO
(718) 930-5259
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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