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OPTUM PHARMACY 702, LLC
DSH240020 CAMBRIDGE MEDICAL CENTER
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Covered Entity Details
Entity Name
CAMBRIDGE MEDICAL CENTER
Subdivision Name
Hospital
Type
Disproportionate Share Hospital
340B ID
DSH240020
Entity Address
701 SOUTH DELLWOOD
CAMBRIDGE, MN 55008
Medicare Provider Number
240020
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/10/2023
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