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OPTUM PHARMACY 702, LLC
DSH110064 THE MEDICAL CENTER, INC. dba Piedmont Columbus Regional Midtown
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Covered Entity Details
Entity Name
THE MEDICAL CENTER, INC. dba Piedmont Columbus Regional Midtown
Subdivision Name
THE MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH110064
Entity Address
710 CENTER STREET
COLUMBUS, GA 31901
Medicare Provider Number
110064
Participating Start Date
7/1/1995
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
M. Scott Hill, CEO
(706) 660-6103
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/10/2023
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