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OPTUM PHARMACY 702, LLC
DSH160058 UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160058
Entity Address
200 HAWKINS DRIVE
IOWA CITY, IA 52242
Medicare Provider Number
160058
Participating Start Date
10/1/1999
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
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2022
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