Contract Pharmacy Details

OPTUM INFUSION SERVICES 404 LLC
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF WASHINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500008

Entity Address

1959 NE PACIFIC ST.,
SEATTLE, WA 98195

Medicare Provider Number

500008

Participating Start Date

12/1/1992

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 404 LLC

Pharmacy Address

2065 NE WILLIAMSON CT
STE B
BEND, OR 97701

Pharmacy Comments

Contract Details

Approval Date

10/8/2020

Contract Begin Date

10/13/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

10/8/2020

340B Drug Pricing Program Database