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OPTUM PHARMACY 705, LLC
DSH330285 STRONG MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STRONG MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330285
Entity Address
601 Elmwood Avenue
ROCHESTER, NY 14642
Medicare Provider Number
330285
Participating Start Date
10/1/2003
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Fuller Spencer, Chief Financial Officer
(585) 275-3033
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/16/2017
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