340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH261302-00 MADISON MEDICAL CENTER
Print
Covered Entity Details
Entity Name
MADISON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261302-00
Entity Address
611 WEST MAIN STREET
FREDERICKTOWN, MO 63645
Medicare Provider Number
261302
Participating Start Date
12/9/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Twidwell, CEO
(573) 783-1020 Ext: 3311
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/19/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session