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OPTUM PHARMACY 702, LLC
DSH190039 WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
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Covered Entity Details
Entity Name
WEST JEFFERSON HOLDINGS, LLC D/B/A WEST JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190039
Entity Address
1101 MEDICAL CENTER BLVD
MARRERO, LA 70072
Medicare Provider Number
190039
Participating Start Date
11/25/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Eli Smith, Chief Operating Officer—West Jefferson Medical Center
(504) 349-1105
Contract Pharmacy Representative
Optum
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2022
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