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OPTUM INFUSION SERVICES 101, INC.
PED393303-00 THE CHILDREN'S HOSPITAL OF PHILADELPHIA
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Covered Entity Details
Entity Name
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
Type
Children's Hospital
340B ID
PED393303-00
Entity Address
3401 Civic Center Blvd
PHILADELPHIA, PA 19104
Medicare Provider Number
393303
Participating Start Date
1/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 101, INC.
Pharmacy Address
931 CONKLIN ST STE D
FARMINGDALE, NY 11735-2429
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Dole, SVP and COO Main Hospital, Philadelphia Campus
(267) 426-2452
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2023
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