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OPTUM PHARMACY 702, LLC
DSH360003 University of Cincinnati Medical Center LLC
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Covered Entity Details
Entity Name
University of Cincinnati Medical Center LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360003
Entity Address
3188 Bellevue Avenue
CINCINNATI, OH 45219
Medicare Provider Number
360003
Participating Start Date
12/1/1992
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RICK HINDS, Executive Vice President and Chief Financial Officer
(513) 585-8720
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
7/11/2019
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