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OPTUM PHARMACY 705, LLC
CAH141331-00 MARSHALL BROWNING HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
MARSHALL BROWNING HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141331-00
Entity Address
900 NORTH WASHINGTON STREET
DU QUOIN, IL 62832
Medicare Provider Number
141331
Participating Start Date
10/1/2016
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Eaves, CEO
(618) 542-1042
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2020
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