Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
DSH150074 Community Health Network, Inc.

Covered Entity Details

Entity Name

Community Health Network, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150074

Entity Address

1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219

Medicare Provider Number

150074

Participating Start Date

4/1/2008

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

1/7/2021

Contract Begin Date

1/18/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David Kiley, President
(317) 621-9337

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

1/7/2021

340B Drug Pricing Program Database