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OPTUM PHARMACY 702, LLC
CAH191325-00 LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LAFOURCHE HOSPITAL SERVICE DISTRICT #1 DBA LADY OF THE SEA GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191325-00
Entity Address
200 WEST 134TH PLACE
CUT OFF, LA 70345
Medicare Provider Number
191325
Participating Start Date
9/14/2010
Last Recertification Date
8/15/2024
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
10/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen S. Collins, C.E.O.
(985) 632-8286
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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