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OPTUM PHARMACY 702, LLC
DSH060030 BANNER MCKEE MEDICAL CENTER
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Covered Entity Details
Entity Name
BANNER MCKEE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060030
Entity Address
2000 BOISE AVENUE
LOVELAND, CO 80538
Medicare Provider Number
060030
Participating Start Date
3/15/2022
Last Recertification Date
8/30/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/27/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew P Huff, CFO
(480) 543-2277
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2020
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