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OPTUM PHARMACY 702, LLC
CAH441309-00 MARSHALL MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHALL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH441309-00
Entity Address
1080 NORTH ELLINGTON PKWY
LEWISBURG, TN 37091
Medicare Provider Number
441309
Participating Start Date
9/21/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/19/2022
Contract Begin Date
2/28/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHYLLIS BROWN, CHIEF EXECUTIVE OFFICER
(931) 359-6241 Ext: 3306
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/19/2022
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