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OPTUM PHARMACY 702, LLC
RRC520098-00 UNIVERSITY OF WI HOSPITALS & CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520098-00
Entity Address
600 HIGHLAND AVE
MADISON, WI 53792
Medicare Provider Number
520098
Participating Start Date
10/1/2020
Last Recertification Date
8/28/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/28/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2020
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