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OPTUM PHARMACY 702, LLC
CAH421301-00 ABBEVILLE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH421301-00
Entity Address
420 THOMSON CIRCLE
ABBEVILLE, SC 29620
Medicare Provider Number
421301
Participating Start Date
8/19/2010
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Willis Grant, Interim Chief Financial Officer
(864) 366-3310
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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