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OPTUM INFUSION SERVICES 204, INC
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 204, INC
Pharmacy Address
4220 EXECUTIVE CIRCLE, SUITE 62
FORT MYERS, FL 33916
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kymberlee Manni, CEO
(305) 689-4515
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2021
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