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OPTUM PHARMACY 702, LLC
DSH450431 ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450431
Entity Address
919 EAST 32ND STREET
AUSTIN, TX 78705
Medicare Provider Number
450431
Participating Start Date
4/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
10/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Steward, CEO
(512) 544-4215
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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