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OPTUM PHARMACY 702, LLC
HV07849 WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
Washington University Infectious Diseases Clinic
Type
Ryan White Part C
340B ID
HV07849
Entity Address
620 S TAYLOR AVENUE
SUITE 100
SAINT LOUIS, MO 63110-1010
Grant Number
H76HA07849
Participating Start Date
4/1/2010
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tina M Markovich, Program Director
(314) 747-3071
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2020
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