Contract Pharmacy Details

OPTUM PHARMACY 700, LLC
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS

Covered Entity Details

Entity Name

METHODIST MEDICAL CENTER OF ILLINOIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140209

Entity Address

221 NE GLEN OAK AVE.
PEORIA, IL 61636

Medicare Provider Number

140209

Participating Start Date

10/1/2006

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 700, LLC

Pharmacy Address

5700 DOT COM CT, STE 1000
OVIEDO, FL 32765

Pharmacy Comments

Contract Details

Approval Date

10/14/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Keith E. Knepp, CEO
(309) 671-2528

Contract Pharmacy Representative

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

Signed By Date

10/14/2022

340B Drug Pricing Program Database