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OPTUM PHARMACY 701, LLC
CAH061307-00 Rangely Hospital District
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Covered Entity Details
Entity Name
Rangely Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061307-00
Entity Address
225 Eagle Crest St
Rangely, CO 81648
Medicare Provider Number
061307
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
10/20/2022
Contract Begin Date
11/7/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kyle Wren, CEO
(970) 675-4219
Contract Pharmacy Representative
Optum Pharmacy
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
10/20/2022
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