Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
DSH370093 OU MEDICAL CENTER

Covered Entity Details

Entity Name

OU MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370093

Entity Address

700 NE 13TH ST.
OKLAHOMA CITY, OK 73104

Medicare Provider Number

370093

Participating Start Date

7/1/2018

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 701, LLC

Pharmacy Address

1830 S HORNE
MESA, AZ 85204

Pharmacy Comments

Contract Details

Approval Date

1/12/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Krystal L Murer, Vice President | Ethics, Regulatory Affairs, and Chief Compliance Officer
(405) 271-8052

Contract Pharmacy Representative

Optum
Nancy Mccuthcheon, Senior VP of Strategic Sales
(651) 983-0677

Signed By Date

1/12/2024

340B Drug Pricing Program Database