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OPTUM PHARMACY 705, LLC
CAH151331-00 HARRISON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
HARRISON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151331-00
Entity Address
1141 HOSPITAL DRIVE N.W
CORYDON, IN 47112
Medicare Provider Number
151331
Participating Start Date
8/4/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Marie Lieber, Chief Administrative Officer
(812) 738-7884
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/10/2022
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