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OPTUM INFUSION SERVICES 501, INC.
HM83712 ST LUKE'S REGIONAL MEDICAL CENTER, LTD
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Covered Entity Details
Entity Name
ST LUKE'S REGIONAL MEDICAL CENTER, LTD
Subdivision Name
ST. LUKE'S HEMOPHILIA CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM83712
Entity Address
100 E. IDAHO ST.
BOISE, ID 83712
Grant Number
H30MC240491300
Participating Start Date
1/1/2007
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 501, INC.
Pharmacy Address
8131 W BOSTIAN RD
STE. A345
WOODINVILLE, WA 98072
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kate Fowler, Senior VP & CFO
(208) 381-8717
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/16/2024
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