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OPTUM INFUSION SERVICES 305, LLC
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390174
Entity Address
111 South 11th Street
Philadelphia, PA 19107
Medicare Provider Number
390174
Participating Start Date
4/1/2006
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 305, LLC
Pharmacy Address
4000 CHEMICAL RD STE 100
PLYMOUTH MEETING, PA 19462
Pharmacy Comments
Contract Details
Approval Date
7/16/2021
Contract Begin Date
8/3/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/16/2021
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