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OPTUM PHARMACY 702, LLC
DSH340070 ALAMANCE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ALAMANCE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340070
Entity Address
1240 HUFFMAN MILL ROAD
BURLINGTON, NC 27215
Medicare Provider Number
340070
Participating Start Date
7/1/2015
Last Recertification Date
8/29/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey Jones, Executive VP and CFO
(336) 832-8005
Contract Pharmacy Representative
BriovaRX of Maine
Jeffrey Grosklags, CFO
(952) 205-1000
Signed By Date
4/15/2016
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