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OPTUM PHARMACY 705, LLC
SCH250095-00 South Sunflower County Hospital
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Covered Entity Details
Entity Name
South Sunflower County Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250095-00
Entity Address
121 East Baker Street
Indianola, MS 38751-2462
Medicare Provider Number
250095
Participating Start Date
10/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Courtney Phillips, Administrator/CFO
(662) 635-7200
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2022
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