Contract Pharmacy Details

OPTUM INFUSION SERVICES 202, INC.
HM12010 University Medical Services Association, Inc.

Covered Entity Details

Entity Name

University Medical Services Association, Inc.

Subdivision Name

USF Comprehensive Hemophilia Treatment Center

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM12010

Entity Address

12901 Bruce B. Downs Blvd, MDC 19
TAMPA, FL 33612

Grant Number

H30MC24046

Participating Start Date

1/1/2000

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 202, INC.

Pharmacy Address

9655 FLORIDA MINING BLVD W
STE 411
JACKSONVILLE, FL 32257-2041

Pharmacy Comments

Contract Details

Approval Date

4/15/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Renee Marie Dubault, Chief Executive Officer
(813) 974-0329

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2024

340B Drug Pricing Program Database