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OPTUM PHARMACY 700, LLC
HM13100 SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
Subdivision Name
The John Bouhasin Center for Children with Bleeding Disorders
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM13100
Entity Address
1465 S GRAND
ST LOUIS, MO 63104-1095
Grant Number
H30MC24051
Participating Start Date
7/1/2006
Last Recertification Date
2/14/2025
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
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2023
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