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OPTUM PHARMACY 702, LLC
DSH520098 UNIVERSITY OF WI HOSPITALS & CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520098
Entity Address
600 HIGHLAND AVE
MADISON, WI 53792
Medicare Provider Number
520098
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/6/2022
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