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OPTUM PHARMACY 801, INC.
DSH140114 SWEDISH COVENANT HEALTH
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Covered Entity Details
Entity Name
SWEDISH COVENANT HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140114
Entity Address
5145 N CALIFORNIA
CHICAGO, IL 60625
Medicare Provider Number
140114
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
7/14/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia King, Vice President Legal Affairs
(773) 989-8811
Contract Pharmacy Representative
Avella/Briova/Diplomat/Optum
Dorothy M Janetka, 340B HDP Inventory Specialist
(224) 231-1180
Signed By Date
7/14/2020
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