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OPTUM PHARMACY 701, LLC
DSH030006 TUCSON MEDICAL CENTER
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Covered Entity Details
Entity Name
TUCSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030006
Entity Address
5301 E GRANT ROAD
TUCSON, AZ 85712
Medicare Provider Number
030006
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Maureen Coomler, Chief Operating Officer
(520) 324-4450
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/17/2022
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