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OPTUM PHARMACY 702, LLC
DSH440015 UNIVERSITY OF TENNESSEE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440015
Entity Address
1924 ALCOA HWY
KNOXVILLE, TN 37920
Medicare Provider Number
440015
Participating Start Date
7/1/2001
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Robert Ross, Senior Vice President, Strategic Development
(865) 305-6400
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
4/13/2018
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