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OPTUM PHARMACY 702, LLC
DSH510062 APPALACHIAN REGIONAL HEALTHCARE, INC.
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Covered Entity Details
Entity Name
APPALACHIAN REGIONAL HEALTHCARE, INC.
Subdivision Name
DBA BECKLEY ARH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH510062
Entity Address
306 STANAFORD ROAD
BECKLEY, WV 25801
Medicare Provider Number
510062
Participating Start Date
4/1/2010
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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