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OPTUM PHARMACY 702, LLC
DSH360027 AKRON GENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AKRON GENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360027
Entity Address
1 AKRON GENERAL AVE
AKRON, OH 44307
Medicare Provider Number
360027
Participating Start Date
7/1/2021
Last Recertification Date
8/22/2023
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
6/2/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Harte, President
(330) 344-6548
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2021
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