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OPTUM PHARMACY 702, LLC
DSH500027 SWEDISH MEDICAL CENTER
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Covered Entity Details
Entity Name
SWEDISH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500027
Entity Address
747 BROADWAY
SEATTLE, WA 98122
Medicare Provider Number
500027
Participating Start Date
7/1/2006
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stan Moser, CFO
(206) 628-2549
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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