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OPTUM PHARMACY 701, LLC
DSH140080 PRESENCE SAINT FRANCIS HOSPITAL
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Covered Entity Details
Entity Name
PRESENCE SAINT FRANCIS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140080
Entity Address
355 RIDGE AVE.
EVANSTON, IL 60202
Medicare Provider Number
140080
Participating Start Date
7/1/2007
Last Recertification Date
8/16/2024
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
7/17/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Flavio Marin, CFO
(847) 316-4190
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/17/2021
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