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OPTUM PHARMACY 701, LLC
DSH460009 University of Utah
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Covered Entity Details
Entity Name
University of Utah
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460009
Entity Address
50 North Medical Drive
Salt Lake City, UT 84132
Medicare Provider Number
460009
Participating Start Date
7/1/1996
Last Recertification Date
8/19/2024
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
Charlton Gordon Park, Chief Financial Officer
(801) 585-1325
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/12/2024
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