Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
DSH520075 ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Covered Entity Details

Entity Name

ST.VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520075

Entity Address

835 S.VAN BUREN STREET
GREEN BAY, WI 54301

Medicare Provider Number

520075

Participating Start Date

1/1/2010

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 701, LLC

Pharmacy Address

8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Patty Allen, Chief Financial Officer
(920) 884-5660

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/15/2021

340B Drug Pricing Program Database