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OPTUM PHARMACY 702, LLC
DSH180093 Baptist Health Deaconess Madisonville
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Covered Entity Details
Entity Name
Baptist Health Deaconess Madisonville
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180093
Entity Address
900 HOSPITAL DRIVE
MADISONVILLE, KY 42431
Medicare Provider Number
180093
Participating Start Date
1/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Ashby, Vice President of Finance
(270) 825-5781
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/6/2023
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