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OPTUM PHARMACY 702, LLC
SCH450348-00 FALLS COMMUNITY HOSPITAL AND CLINIC
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Covered Entity Details
Entity Name
FALLS COMMUNITY HOSPITAL AND CLINIC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450348-00
Entity Address
322 COLEMAN
MARLIN, TX 76661
Medicare Provider Number
450348
Participating Start Date
1/1/2017
Last Recertification Date
9/15/2021
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jessica Ford, Human Resources
(254) 803-3561 Ext: 2102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/8/2021
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