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OPTUM PHARMACY 702, LLC
CAH241378-00 NEW ULM MEDICAL CENTER
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Covered Entity Details
Entity Name
NEW ULM MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241378-00
Entity Address
1324 5TH NORTH ST
NEW ULM, MN 56073
Medicare Provider Number
241378
Participating Start Date
8/6/2010
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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