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OPTUM PHARMACY 702, LLC
RRC440073-00 Maury Regional Hospital
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Covered Entity Details
Entity Name
Maury Regional Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440073-00
Entity Address
1224 Trotwood Ave
Columbia, TN 38401
Medicare Provider Number
440073
Participating Start Date
7/1/2013
Last Recertification Date
8/31/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/21/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Deborah Lumpkins, Sr. VP/CNO
(931) 490-7118
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/21/2019
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