340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
DSH060012 St. Mary-Corwin Hospital
Print
Covered Entity Details
Entity Name
St. Mary-Corwin Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060012
Entity Address
1008 Minnequa Avenue
Pueblo, CO 81004
Medicare Provider Number
060012
Participating Start Date
4/1/2014
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Cafasso, Chief Executive Officer
(719) 557-4678
Contract Pharmacy Representative
Avella
Tammy Sievert, 340B Implementation and Analytics Manager, Corportate
(602) 769-3073
Signed By Date
10/14/2019
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