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OPTUM PHARMACY 704, INC.
HV07849A WASHINGTON UNIVERSITY IN ST. LOUIS
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Covered Entity Details
Entity Name
WASHINGTON UNIVERSITY IN ST. LOUIS
Subdivision Name
Washington University Infectious Diseases Clinic North County
Type
Ryan White Part C
340B ID
HV07849A
Entity Address
1 VILLAGE SQ SHOPPING CTR
SUITE 1
HAZELWOOD, MO 63042-1817
Grant Number
H76HA07849
Participating Start Date
1/1/2023
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tina M Markovich, Program Director
(314) 747-3071
Contract Pharmacy Representative
Optum
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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