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OPTUM PHARMACY 702, LLC
DSH420070 PRISMA HEALTH TUOMEY HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH TUOMEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420070
Entity Address
129 N WASHINGTON ST
SUMTER, SC 29150-4949
Medicare Provider Number
420070
Participating Start Date
4/1/2006
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Browne, Operations Executive
(803) 774-9017
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2021
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