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OPTUM PHARMACY 702, LLC
SCH490018-00 AUGUSTA MEDICAL CENTER
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Covered Entity Details
Entity Name
AUGUSTA MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490018-00
Entity Address
78 MEDICAL CENTER DRIVE
FISHERSVILLE, VA 22939
Medicare Provider Number
490018
Participating Start Date
7/1/2020
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/18/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen C Clark, Vice President of Operations
(540) 332-4800
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2021
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