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OPTUM PHARMACY 705, LLC
DSH180069 TUG VALLEY ARH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TUG VALLEY ARH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180069
Entity Address
260 HOSPITAL DRIVE
SOUTH WILLIAMSON, KY 41503
Medicare Provider Number
180069
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/8/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/8/2022
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