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OPTUM PHARMACY 702, LLC
DSH180088 NORTON HOSPITALS, INC
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Covered Entity Details
Entity Name
NORTON HOSPITALS, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180088
Entity Address
200 East Chestnut Street
LOUISVILLE, KY 40202
Medicare Provider Number
180088
Participating Start Date
1/1/2004
Last Recertification Date
8/27/2024
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
Adam David Kempf, CFO
(502) 420-2255
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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