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OPTUM PHARMACY 702, LLC
DSH140119 RUSH UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
RUSH UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140119
Entity Address
1653 W CONGRESS PKWY
CHICAGO, IL 60612
Medicare Provider Number
140119
Participating Start Date
12/1/2005
Last Recertification Date
9/6/2024
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
John Mordach, Chief Financial Officer
(312) 942-5600
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2019
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