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OPTUM INFUSION SERVICES 500, INC.
HM1589 CHILDREN'S HOSPITAL OF PHILADELPHIA
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Covered Entity Details
Entity Name
CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
HEMOPHILIA PROGRAM AND INFUSION CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM1589
Entity Address
3500 Civic Center Blvd
Children's Hospital of Philadelphia, Division of Hematology
Buerger Center for Advanced Pediatric Care, 3rd Floor
PHILADELPHIA, PA 19104
Grant Number
H30MC48960
Participating Start Date
7/1/1995
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
19 CHAPIN RD BLDG D
SUITE D7
PINE BROOK, NJ 07058-9385
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
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
4/14/2023
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