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OPTUM PHARMACY 702, LLC
CAH161337-00 VAN BUREN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
VAN BUREN COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161337-00
Entity Address
304 FRANKLIN STREET
KEOSAUQUA, IA 52565-0070
Medicare Provider Number
161337
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kara McEntee, CFO
(319) 293-8722
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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