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OPTUM PHARMACY 702, LLC
DSH440050 Greeneville Community Hospital
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Covered Entity Details
Entity Name
Greeneville Community Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440050
Entity Address
1420 Tusculum Blvd
GREENEVILLE, TN 37745
Medicare Provider Number
440050
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/16/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/16/2020
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