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OPTUM PHARMACY 702, LLC
CH047060 LITTLE RIVER MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
LITTLE RIVER MEDICAL CENTER, INC.
Subdivision Name
LITTLE RIVER MEDICAL CENTER, INC.: MAIN SITE
Type
HRSA-Funded Health Center
340B ID
CH047060
Entity Address
4303 Live Oak Dr.
Little River, SC 29566
Grant Number
H80CS00700
Participating Start Date
12/1/1992
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
5/17/2023
Contract Begin Date
5/23/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAMELA R. DAVIS, CEO
(843) 663-8001
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
5/17/2023
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