340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 705, LLC
DSH170145 COFFEYVILLE REG MEDICAL CENTER INC.
Print
Covered Entity Details
Entity Name
COFFEYVILLE REG MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170145
Entity Address
1400 WEST 4TH STREET
COFFEYVILLE, KS 67337
Medicare Provider Number
170145
Participating Start Date
5/25/2022
Last Recertification Date
8/31/2023
Entity Termination Date
5/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
6/1/2022
Contract Begin Date
6/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Heath Lawrence, CEO
(620) 252-1519
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
6/1/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session