Contract Pharmacy Details

OPTUM PHARMACY 801, INC.
DSH370093 OU MEDICAL CENTER

Covered Entity Details

Entity Name

OU MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370093

Entity Address

700 NE 13TH ST.
OKLAHOMA CITY, OK 73104

Medicare Provider Number

370093

Participating Start Date

7/1/2018

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 801, INC.

Pharmacy Address

24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085

Pharmacy Comments

Contract Details

Approval Date

10/7/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

James Michael Watson, CFO
(405) 271-5100

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677

Signed By Date

10/7/2019

340B Drug Pricing Program Database