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OPTUM PHARMACY 702, LLC
DSH230015 THREE RIVERS HEALTH
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Covered Entity Details
Entity Name
THREE RIVERS HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230015
Entity Address
701 S. HEALTH PARKWAY
THREE RIVERS, MI 49093
Medicare Provider Number
230015
Participating Start Date
10/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEVEN T. ANDREWS, CFO
(269) 273-9604
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/14/2021
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