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OPTUM PHARMACY 702, LLC
CAH191323-00 Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
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Covered Entity Details
Entity Name
Hospital Service District 1A, Parish of Richland, State of Louisiana, DBA Richland Parish Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191323-00
Entity Address
407 Cincinnati Street
Delhi, LA 71232-3008
Medicare Provider Number
191323
Participating Start Date
7/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/28/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Carroll, CEO
(318) 878-6323
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/10/2018
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