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OPTUM PHARMACY 702, LLC
HM04055 Maine Medical Center
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Covered Entity Details
Entity Name
Maine Medical Center
Subdivision Name
Northern Light Cancer Care
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM04055
Entity Address
33 Whiting Hill Rd
31
Brewer, ME 04412
Grant Number
H30MC24048
Participating Start Date
1/1/2020
Last Recertification Date
2/8/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lugene Anthony Inzana, CFO
(207) 662-2654
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/6/2023
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