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OPTUM PHARMACY 700, LLC
DSH260078 Ozarks Medical Center DBA Ozarks Healthcare
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Covered Entity Details
Entity Name
Ozarks Medical Center DBA Ozarks Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260078
Entity Address
1100 KENTUCKY AVENUE
WEST PLAINS, MO 65775-1100
Medicare Provider Number
260078
Participating Start Date
1/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
7/23/2021
Contract Begin Date
9/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Contract Pharmacy Representative
Ozarks Medical Center DBA Ozarks Healthcare
Katie Mahan, Director of 340B and Specialty Pharmacy Services
(417) 505-7700
Signed By Date
7/23/2021
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