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OPTUM PHARMACY 702, LLC
CAH191312-00 CHRISTUS Health Central Louisiana DBA CHRISTUS Coushatta Health Care Center
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Covered Entity Details
Entity Name
CHRISTUS Health Central Louisiana DBA CHRISTUS Coushatta Health Care Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191312-00
Entity Address
1635 Marvel Street
Coushatta, LA 71019
Medicare Provider Number
191312
Participating Start Date
1/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Merryman, EVP/CFO
(318) 561-7172
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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