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OPTUM PHARMACY 702, LLC
RRC390133-00 LEHIGH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
LEHIGH VALLEY HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390133-00
Entity Address
1200 South Cedar Crest Boulevard
Allentown, PA 18103
Medicare Provider Number
390133
Participating Start Date
1/1/2018
Last Recertification Date
8/31/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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