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OPTUM PHARMACY 702, LLC
DSH030006 TUCSON MEDICAL CENTER
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Covered Entity Details
Entity Name
TUCSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030006
Entity Address
5301 E GRANT ROAD
TUCSON, AZ 85712
Medicare Provider Number
030006
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
11/3/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maureen Coomler, Chief Operating Officer
(520) 324-4450
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2020
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