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OPTUM PHARMACY 702, LLC
CAH061325-00 PIONEERS MEDICAL CENTER
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Covered Entity Details
Entity Name
PIONEERS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061325-00
Entity Address
100 PIONEERS MEDICAL CENTER DRIVE
MEEKER, CO 81641
Medicare Provider Number
061325
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Liz Sellers, CEO
(970) 878-9260
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2021
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