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OPTUM PHARMACY 702, LLC
DSH270012 BENEFIS HOSPITALS INC.
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Covered Entity Details
Entity Name
BENEFIS HOSPITALS INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270012
Entity Address
1101 26TH STREET SOUTH
GREAT FALLS, MT 59405
Medicare Provider Number
270012
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
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
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Forrest Ehlinger, Chief Financial Officer
(406) 455-5479
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2020
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