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OPTUM PHARMACY 702, LLC
DSH060024 UNIVERSITY OF COLORADO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF COLORADO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060024
Entity Address
12605 E 16th Ave
AURORA, CO 80045
Medicare Provider Number
060024
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barbara Ann Carveth, Chief Financial Officer
(720) 848-7773
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/13/2018
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