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OPTUM PHARMACY 702, LLC
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HAZARD ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180029
Entity Address
100 MEDICAL CENTER DRIVE
HAZARD, KY 41701
Medicare Provider Number
180029
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
7/30/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/9/2020
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