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OPTUM INFUSION SERVICES 550, LLC
PED063301-00 Children's Hospital Colorado
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Covered Entity Details
Entity Name
Children's Hospital Colorado
Subdivision Name
Type
Children's Hospital
340B ID
PED063301-00
Entity Address
13123 EAST 16TH AVENUE
AURORA, CO 80045
Medicare Provider Number
063301
Participating Start Date
9/9/2010
Last Recertification Date
9/4/2024
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/17/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2022
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