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OPTUM PHARMACY 705, LLC
DSH240069 OWATONNA HOSPITAL
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Covered Entity Details
Entity Name
OWATONNA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240069
Entity Address
2250 NW 26TH STREET
OWATONNA, MN 55060
Medicare Provider Number
240069
Participating Start Date
1/1/2021
Last Recertification Date
9/6/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
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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