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OPTUM PHARMACY 702, LLC
DSH260138 ST. LUKE'S HOSPITAL OF KANSAS CITY
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Covered Entity Details
Entity Name
ST. LUKE'S HOSPITAL OF KANSAS CITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260138
Entity Address
4401 Wornall Road
KANSAS CITY, MO 64111
Medicare Provider Number
260138
Participating Start Date
10/1/2009
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amy Nachtigal, VP Finance
(816) 932-3318
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/8/2020
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