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OPTUM PHARMACY 702, LLC
CAH281307-00 Saunders Medical Center
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Covered Entity Details
Entity Name
Saunders Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281307-00
Entity Address
1760 COUNTY ROAD "J"
WAHOO, NE 68066
Medicare Provider Number
281307
Participating Start Date
4/1/2011
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
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tyler Toline, CEO
(402) 443-4191 Ext: 370
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/8/2019
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