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OPTUM PHARMACY 702, LLC
CAH281325-00 Brown County Hospital
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Covered Entity Details
Entity Name
Brown County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281325-00
Entity Address
945 E. Zero St.
Ainsworth, NE 69210-1556
Medicare Provider Number
281325
Participating Start Date
4/1/2012
Last Recertification Date
8/26/2024
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
John W Werner, CEO
(402) 387-2800
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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