Contract Pharmacy Details

OPTUM INFUSION SERVICES 550, LLC
DSH030014 HONORHEALTH JOHN C. LINCOLN MED CTR

Covered Entity Details

Entity Name

HONORHEALTH JOHN C. LINCOLN MED CTR

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH030014

Entity Address

250 E Dunlap Ave
Phoenix, AZ 85020

Medicare Provider Number

030014

Participating Start Date

7/1/2015

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 550, LLC

Pharmacy Address

9045 E PIMA CENTER PKWY STE 1
SCOTTSDALE, AZ 85258-4621

Pharmacy Comments

Contract Details

Approval Date

10/15/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/17/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Gary Baker, SVP-CEO-HOSPITAL
(480) 583-0803

Contract Pharmacy Representative

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

Signed By Date

10/15/2021

340B Drug Pricing Program Database