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OPTUM PHARMACY 702, LLC
CAH171338-00 Great Plains of Sabetha, Inc. dba Sabetha Community Hospital
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Covered Entity Details
Entity Name
Great Plains of Sabetha, Inc. dba Sabetha Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171338-00
Entity Address
603 S. 14th St.
Sabetha, KS 66534-0229
Medicare Provider Number
171338
Participating Start Date
10/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lora Key, CEO
(785) 284-2121 Ext: 1568
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/11/2021
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