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OPTUM PHARMACY 702, LLC
DSH260020 MERCY HOSPITAL - ST. LOUIS
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Covered Entity Details
Entity Name
MERCY HOSPITAL - ST. LOUIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260020
Entity Address
615 S. NEW BALLAS ROAD
Main Hospital Pharmacy and JFK Clinic
ST. LOUIS, MO 63141
Medicare Provider Number
260020
Participating Start Date
4/1/2017
Last Recertification Date
8/21/2024
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
Denise Scoffic, VP Finance
(314) 364-3553
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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