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OPTUM PHARMACY 702, LLC
RRC070034-00 NORWALK HOSPITAL
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Covered Entity Details
Entity Name
NORWALK HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070034-00
Entity Address
MAPLE ST
NORWALK, CT 06856
Medicare Provider Number
070034
Participating Start Date
7/1/2024
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
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
4/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Peter R Cordeau, President Norwalk Hospital
(203) 852-2330
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2021
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