Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HIGHLANDS ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180005

Entity Address

5000 KY RT 321
PRESTONSBURG, KY 41653

Medicare Provider Number

180005

Participating Start Date

9/9/2005

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

340B Drug Pricing Program Database