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OPTUM PHARMACY 702, LLC
DSH070003 Day Kimball Hospital
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Covered Entity Details
Entity Name
Day Kimball Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070003
Entity Address
320 Pomfret Street
Putnam, CT 06260-1869
Medicare Provider Number
070003
Participating Start Date
7/1/2013
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
10/13/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul A. Beaudoin, Chief Financial Officer
(860) 928-6541 Ext: 2113
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2019
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