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OPTUM PHARMACY 702, LLC
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS RHINELANDER HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520019-00
Entity Address
2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501
Medicare Provider Number
520019
Participating Start Date
10/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
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
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laurie Oungst, Chief Administrative Officer
(715) 356-8560
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/9/2020
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