Contract Pharmacy Details

OPTUM PHARMACY 705, LLC
CAH301310-00 ANDROSCOGGIN VALLEY HOSPITAL , Inc.

Covered Entity Details

Entity Name

ANDROSCOGGIN VALLEY HOSPITAL , Inc.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH301310-00

Entity Address

59 PAGE HILL ROAD
BERLIN, NH 03570-3542

Medicare Provider Number

301310

Participating Start Date

9/29/2010

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 705, LLC

Pharmacy Address

1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298

Pharmacy Comments

Contract Details

Approval Date

7/6/2022

Contract Begin Date

7/26/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Suzanne Landry, Vice President
(603) 326-5608

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/6/2022

340B Drug Pricing Program Database