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OPTUM PHARMACY 705, LLC
STD631102 WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
Washington University Infectious Diseases Clinic
Type
Sexually Transmitted Diseases
340B ID
STD631102
Entity Address
620 S TAYLOR AVE
SUITE 100
SAINT LOUIS, MO 63110-1035
Grant Number
NU62PS924838
Participating Start Date
7/1/2021
Last Recertification Date
5/14/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/27/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tina M Markovich, Program Director
(314) 747-3071
Contract Pharmacy Representative
Optum
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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