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OPTUM PHARMACY 705, LLC
PED263302-00 The Children's Mercy Hospital
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Covered Entity Details
Entity Name
The Children's Mercy Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED263302-00
Entity Address
2401 Gillham Road
Kansas City, MO 64108
Medicare Provider Number
263302
Participating Start Date
12/8/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
11142 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Cheri Hunt, Senior Vice President for Patient Care Services Chief Nursing Officer
(816) 234-3728
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2020
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