Contract Pharmacy Details

OPTUM PHARMACY 704, INC.
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH470003

Entity Address

111 Colchester Avenue
Burlington, VT 05401

Medicare Provider Number

470003

Participating Start Date

4/1/2005

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 704, INC.

Pharmacy Address

5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249

Pharmacy Comments

Contract Details

Approval Date

1/4/2022

Contract Begin Date

1/21/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christina Oliver, VP of Clinical Services
(802) 847-2805

Contract Pharmacy Representative

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

Signed By Date

1/4/2022

340B Drug Pricing Program Database