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OPTUM PHARMACY 701, LLC
RRC140223-00 ADVOCATE LUTHERAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140223-00
Entity Address
1775 W. DEMPSTER STREET
PARK RIDGE, IL 60068
Medicare Provider Number
140223
Participating Start Date
4/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nan Nelson, SVP-Finance
(414) 378-4765
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2020
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