340B Drug Pricing Program Database
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OPTUM INFUSION SERVICES 500, INC.
HM683 Versiti Wisconsin, Inc.
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Covered Entity Details
Entity Name
Versiti Wisconsin, Inc.
Subdivision Name
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM683
Entity Address
638 N 18TH STREET
MILWAUKEE, WI 53233
Grant Number
H30MC24052
Participating Start Date
1/1/1997
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
4900 RIVERGRADE RD STE E120
IRWINDALE, CA 91706-1419
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Meg Coffey McElligott, Chief Quality Officer
(414) 937-6346
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
7/7/2021
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