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OPTUM PHARMACY 702, LLC
CAH201315-00 MAINEHEALTH STEPHENS HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH STEPHENS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201315-00
Entity Address
181 Main Street
Norway, ME 04268
Medicare Provider Number
201315
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John W. Cox, Chief Financial Officer
(207) 744-6024
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/10/2020
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