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OPTUM PHARMACY 702, LLC
CAH331320-00 Bassett Hospital of Schoharie County dba Cobleskill Regional Hospital
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Covered Entity Details
Entity Name
Bassett Hospital of Schoharie County dba Cobleskill Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331320-00
Entity Address
178 Grandview Drive
Cobleskill, NY 12043
Medicare Provider Number
331320
Participating Start Date
10/1/2019
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Swinko, CFO
(607) 547-3096
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2021
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