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OPTUM PHARMACY 701, LLC
DSH520098 UNIVERSITY OF WI HOSPITALS & CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF WI HOSPITALS & CLINICS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520098
Entity Address
600 HIGHLAND AVE
MADISON, WI 53792
Medicare Provider Number
520098
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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