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OPTUM PHARMACY 702, LLC
DSH070036 UCONN HEALTH
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Covered Entity Details
Entity Name
UCONN HEALTH
Subdivision Name
JOHN DEMPSEY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH070036
Entity Address
263 FARMINGTON AVENUE
GPS/Patient way-finding: 100 Hospital Drive
FARMINGTON, CT 06032
Medicare Provider Number
070036
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
10/23/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Metcalf, AVP Pharmacy and Ancillary Services
(860) 679-7943
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/6/2020
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