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OPTUM PHARMACY 702, LLC
PED043300-00 ARKANSAS CHILDRENS HOSPITAL
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Covered Entity Details
Entity Name
ARKANSAS CHILDRENS HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED043300-00
Entity Address
1 CHILDRENS WAY
LITTLE ROCK, AR 72202
Medicare Provider Number
043300
Participating Start Date
4/1/2020
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
2/12/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gena Wingfield, Chief Financial Officer/Executive Vice President
(501) 364-2555
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2021
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