Contract Pharmacy Details

OPTUM INFUSION SERVICES 500, INC.
HM11963 UNIVERSITY OF ARIZONA-Department of Medicine

Covered Entity Details

Entity Name

UNIVERSITY OF ARIZONA-Department of Medicine

Subdivision Name

ARIZONA HEMOSTASIS & THROMBOSIS CENTER

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM11963

Entity Address

Arizona Hemostasis & Thrombosis Center
1515 N Campbell Ave
TUCSON, AZ 85724

Grant Number

H30MC2409

Participating Start Date

4/1/1993

Last Recertification Date

2/17/2025

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

8/6/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/2/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Elisha Johnson, Director, Clinical Trials and Contracting
(520) 626-7822

Contract Pharmacy Representative

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

Signed By Date

8/6/2021

340B Drug Pricing Program Database