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OPTUM PHARMACY 702, LLC
CAH191326-00 REEVES MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
REEVES MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191326-00
Entity Address
409 FIRST ST.
BERNICE, LA 71222
Medicare Provider Number
191326
Participating Start Date
1/1/2018
Last Recertification Date
8/22/2024
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
Contacts
Covered Entity Signing Official
David Matthew Caston, CEO
(318) 285-7762
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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