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OPTUM PHARMACY 702, LLC
DSH340130 ATRIUM HEALTH UNION
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Covered Entity Details
Entity Name
ATRIUM HEALTH UNION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340130
Entity Address
600 HOSPITAL DRIVE
MONROE, NC 28111
Medicare Provider Number
340130
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/18/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/18/2021
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