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OPTUM PHARMACY 701, LLC
DSH060107 NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
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Covered Entity Details
Entity Name
NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060107
Entity Address
1400 JACKSON STREET
DENVER, CO 80206
Medicare Provider Number
060107
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHRISTINE FORKNER, CFO
(303) 398-1004
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/5/2023
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