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OPTUM PHARMACY 702, LLC
CAH261324-00 CASS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CASS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261324-00
Entity Address
2800 E ROCK HAVEN ROAD
HARRISONVILLE, MO 64701
Medicare Provider Number
261324
Participating Start Date
4/1/2011
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
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRENT PROBASCO, CFO
(816) 380-5888 Ext: 6610
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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