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OPTUM PHARMACY 702, LLC
PED243302-00 Children’s Health Care d/b/a Children’s Minnesota
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Covered Entity Details
Entity Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
MINNEAPOLIS CAMPUS
Type
Children's Hospital
340B ID
PED243302-00
Entity Address
2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS, MN 55404
Medicare Provider Number
243302
Participating Start Date
1/1/2015
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christa Steene-Lyons, Compliance Officer
(612) 813-6316
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/11/2024
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