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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
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beth Duffy, Chief Operating Officer
(484) 622-7004
Contract Pharmacy Representative
Optum
NATHAN WHITE, Vice President Sales - TPA & Hospital
(813) 949-1951
Signed By Date
7/5/2017
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