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OPTUM PHARMACY 702, LLC
CAH261323-00 CEDAR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CEDAR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261323-00
Entity Address
1401 S. PARK STREET
EL DORADO SPRINGS, MO 64744
Medicare Provider Number
261323
Participating Start Date
9/8/2010
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
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JANA WITT, CEO
(417) 876-2511
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2021
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