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OPTUM PHARMACY 702, LLC
DSH450082 CHRISTUS SPOHN HOSPITAL BEEVILLE
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Covered Entity Details
Entity Name
CHRISTUS SPOHN HOSPITAL BEEVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450082
Entity Address
1500 E. HOUSTON
BEEVILLE, TX 78102
Medicare Provider Number
450082
Participating Start Date
12/16/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
6/10/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Becky Rios, Interim CFO
(361) 881-3157
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2020
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