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OPTUM PHARMACY 702, LLC
CAH271347-00 Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital
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Covered Entity Details
Entity Name
Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271347-00
Entity Address
2600 Wilson Street
Miles City, MT 59301
Medicare Provider Number
271347
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
1/23/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pam Palagi, VP Financial Services
(406) 723-2414
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2023
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