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OPTUM PHARMACY 702, LLC
DSH150056 INDIANA UNIVERSITY HEALTH INC
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
Methodist Hospital
Type
Disproportionate Share Hospital
340B ID
DSH150056
Entity Address
1701 N. Senate Blvd
INDIANAPOLIS, IN 46202
Medicare Provider Number
150056
Participating Start Date
4/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/14/2021
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