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OPTUM PHARMACY 702, LLC
CAH141329-00 MORRISON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MORRISON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141329-00
Entity Address
303 N. JACKSON STREET
MORRISON, IL 61270
Medicare Provider Number
141329
Participating Start Date
1/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/2/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cami Megli, CFO
(815) 772-5533 Ext: 284
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/2/2020
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