Contract Pharmacy Details

OPTUM PHARMACY 705, LLC
HV07849 WASHINGTON UNIVERSITY IN ST. LOUIS

Covered Entity Details

Entity Name

WASHINGTON UNIVERSITY IN ST. LOUIS

Subdivision Name

Washington University Infectious Diseases Clinic

Type

Ryan White Part C

340B ID

HV07849

Entity Address

620 S TAYLOR AVENUE
SUITE 100
SAINT LOUIS, MO 63110-1010

Grant Number

H76HA07849

Participating Start Date

4/1/2010

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 705, LLC

Pharmacy Address

1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

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

340B Drug Pricing Program Database