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OPTUM PHARMACY 702, LLC
CAH301307-00 MaineHealth Memorial Hospital
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Covered Entity Details
Entity Name
MaineHealth Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301307-00
Entity Address
3073 White Mountain Hwy
North Conway, NH 03860-7101
Medicare Provider Number
301307
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
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
Diana J. McLaughlin, Chief Financial Officer
(603) 356-0613 Ext: 2537
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/10/2020
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