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OPTUM PHARMACY 702, LLC
DSH180141 UNIVERSITY OF LOUISVILLE HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF LOUISVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180141
Entity Address
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Medicare Provider Number
180141
Participating Start Date
7/1/1996
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2019
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