340B Drug Pricing Program Database
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OPTUM PHARMACY 705, LLC
BON SECOURS ST. FRANCIS XAVIER HOSPI
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Covered Entity Details
Entity Name
BON SECOURS ST. FRANCIS XAVIER HOSPI
Subdivision Name
Type
Rural Referral Center
340B ID
Entity Address
2095 HENRY TECKLENBURG DRIVE
CHARLESTON, SC 29414
Medicare Provider Number
420065
Participating Start Date
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
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403
Contract Pharmacy Representative
Bon Secours Saint Francis Hospital
Louis Glavinos, 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager
(843) 402-1675
Signed By Date
4/23/2025
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