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OPTUM PHARMACY 702, LLC
DSH450056 Ascension Seton d/b/a Ascension Seton Medical Center Austin
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Covered Entity Details
Entity Name
Ascension Seton d/b/a Ascension Seton Medical Center Austin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450056
Entity Address
1201 WEST 38TH STREET
AUSTIN, TX 78705
Medicare Provider Number
450056
Participating Start Date
4/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tad Allen Hatton, VP/COO
(512) 484-3507
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
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