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OPTUM PHARMACY 702, LLC
DSH180011 SAINT JOSEPH HEALTH SYSTEM
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Covered Entity Details
Entity Name
SAINT JOSEPH HEALTH SYSTEM
Subdivision Name
DBA SAINT JOSEPH - LONDON
Type
Disproportionate Share Hospital
340B ID
DSH180011
Entity Address
1001 SAINT JOSEPH LANE
LONDON, KY 40741
Medicare Provider Number
180011
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christy Spitser, Vice President of Finance
(606) 330-6016
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
4/12/2019
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