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OPTUM PHARMACY 700, 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 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
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
1/12/2023
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