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OPTUM PHARMACY 702, LLC
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER
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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 PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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
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