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OPTUM PHARMACY 702, LLC
SCH190088-00 SPRINGHILL MEDICAL CENTER - AMENDED
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Covered Entity Details
Entity Name
SPRINGHILL MEDICAL CENTER - AMENDED
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH190088-00
Entity Address
2001 DOCTORS DRIVE
SPRINGHILL, LA 71075
Medicare Provider Number
190088
Participating Start Date
1/1/2018
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael G. Patronis, CEO
(318) 539-1001
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
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