340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
PED453310-00 Ascension Seton d/b/a Dell Children's Medical Center of Central Texas
Print
Covered Entity Details
Entity Name
Ascension Seton d/b/a Dell Children's Medical Center of Central Texas
Subdivision Name
Type
Children's Hospital
340B ID
PED453310-00
Entity Address
4900 MUELLER BOULEVARD
AUSTIN, TX 78723
Medicare Provider Number
453310
Participating Start Date
7/1/2010
Last Recertification Date
8/14/2024
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
Debra Marie Brown, VP, Patient Care Services and COO
(512) 324-0186
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session