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OPTUM PHARMACY 702, LLC
RRC070028-00 ST. VINCENTS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. VINCENTS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070028-00
Entity Address
2800 MAIN STREET
BRIDGEPORT, CT 06606-4201
Medicare Provider Number
070028
Participating Start Date
10/8/2021
Last Recertification Date
9/19/2022
Entity Termination Date
1/13/2023
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
1/13/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Christopher Given, VP, Finance
(475) 210-6193
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/11/2021
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