Contract Pharmacy Details

OPTUM PHARMACY 705, LLC
CAH161344-00 WASHINGTON COUNTY HOSPITAL

Covered Entity Details

Entity Name

WASHINGTON COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161344-00

Entity Address

400 E POLK ST.
WASHINGTON, IA 52353

Medicare Provider Number

161344

Participating Start Date

9/27/2010

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 705, LLC

Pharmacy Address

1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655

Pharmacy Comments

Contract Details

Approval Date

8/3/2021

Contract Begin Date

7/27/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Shelli Cleverley, CFO
(319) 863-3902

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

8/3/2021

340B Drug Pricing Program Database