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OPTUM PHARMACY 702, LLC
DSH060054 COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060054
Entity Address
2351 G ROAD
GRAND JUNCTION, CO 81505
Medicare Provider Number
060054
Participating Start Date
4/1/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
7/29/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christian A. Thomas, CEO
(970) 644-3011
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/19/2021
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