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OPTUM PHARMACY 702, LLC
DSH030038 SCOTTSDALE OSBORN MEDICAL CENTER
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Covered Entity Details
Entity Name
SCOTTSDALE OSBORN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030038
Entity Address
7400 EAST OSBORN ROAD
SCOTTSDALE, AZ 85251
Medicare Provider Number
030038
Participating Start Date
10/1/2018
Last Recertification Date
Entity Termination Date
6/10/2019
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Alice Pope, Chief Financial Officer
(480) 882-5544
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
10/15/2018
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