Contract Pharmacy Details

OPTUMRX
DSH450573 CHRISTUS JASPER MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

CHRISTUS JASPER MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450573

Entity Address

1275 MARVIN HANCOCK DRIVE
JASPER, TX 75951

Medicare Provider Number

450573

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

OPTUMRX

Pharmacy Address

OPTUMRX INC
6800 W 115TH ST STE 600
OVERLAND PARK, KS 66211-9838

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

6/8/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Nikki Martin, Regional Director, Finance
(409) 899-7105

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2020

340B Drug Pricing Program Database