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OPTUM PHARMACY 702, LLC
DSH390256 MILTON S. HERSHEY MEDICAL CENTER
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Covered Entity Details
Entity Name
MILTON S. HERSHEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390256
Entity Address
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Medicare Provider Number
390256
Participating Start Date
4/1/2004
Last Recertification Date
9/24/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie B Nickell, CFO
(717) 531-4631
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2022
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