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OPTUM PHARMACY 702, LLC
CAH271325-00 St. Luke Community Hospital & Nursing Home
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Covered Entity Details
Entity Name
St. Luke Community Hospital & Nursing Home
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271325-00
Entity Address
107 6th Avenue SW
Ronan, MT 59864
Medicare Provider Number
271325
Participating Start Date
10/1/2013
Last Recertification Date
8/20/2024
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
Paul Soukup, CFO
(406) 676-4441 Ext: 291
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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