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OPTUM PHARMACY 702, LLC
DSH360039 GENESIS HEALTHCARE SYSTEM
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Covered Entity Details
Entity Name
GENESIS HEALTHCARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360039
Entity Address
2951 MAPLE AVE.
ZANESVILLE, OH 43701-1406
Medicare Provider Number
360039
Participating Start Date
7/1/2007
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Norman, Chief Financial Officer
(740) 454-4773
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2019
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