340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH461301-00 IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
Print
Covered Entity Details
Entity Name
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461301-00
Entity Address
674 SOUTH HIGHWAY 99
FILLMORE, UT 84631
Medicare Provider Number
461301
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lenny Lyons, Administrator--Delta Community Medical Center
(435) 864-1510
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
4/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session