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OPTUM PHARMACY 702, LLC
DSH520138 AURORA HEALTH CARE METRO, INC.
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Covered Entity Details
Entity Name
AURORA HEALTH CARE METRO, INC.
Subdivision Name
Aurora St. Luke's Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH520138
Entity Address
2900 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Medicare Provider Number
520138
Participating Start Date
10/1/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nanine Nelson, SVP-Finance
(414) 299-1610
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/15/2019
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