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OPTUM PHARMACY 701, LLC
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF WASHINGTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500008
Entity Address
1959 NE PACIFIC ST.,
SEATTLE, WA 98195
Medicare Provider Number
500008
Participating Start Date
12/1/1992
Last Recertification Date
8/28/2024
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
1/14/2021
Contract Begin Date
1/28/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362
Contract Pharmacy Representative
UW Medicine
Sumona Patel, Pharmacy Audit and Compliance Manager
(206) 598-6936
Signed By Date
1/14/2021
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