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OPTUM INFUSION SERVICES 551, LLC
HM1589 CHILDREN'S HOSPITAL OF PHILADELPHIA
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Covered Entity Details
Entity Name
CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
HEMOPHILIA PROGRAM AND INFUSION CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM1589
Entity Address
3500 Civic Center Blvd
Children's Hospital of Philadelphia, Division of Hematology
Buerger Center for Advanced Pediatric Care, 3rd Floor
PHILADELPHIA, PA 19104
Grant Number
H30MC48960
Participating Start Date
7/1/1995
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 551, LLC
Pharmacy Address
100 CORPORATE DR STE 111
WINDSOR, CT 06095
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Thomas Dole, SVP and COO Main Hospital, Philadelphia Campus
(267) 426-2452
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/14/2022
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