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OPTUM PHARMACY 702, LLC
CAH151327-00 Sullivan County Community Hospital
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Covered Entity Details
Entity Name
Sullivan County Community Hospital
Subdivision Name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Type
Critical Access Hospital
340B ID
CAH151327-00
Entity Address
2200 NORTH SECTION STREET
SULLIVAN, IN 47882
Medicare Provider Number
151327
Participating Start Date
9/29/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/18/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELLE FRANKLIN, CHIEF EXECUTIVE OFFICER
(812) 268-4311 Ext: 2372
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/18/2021
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