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OPTUM PHARMACY 705, LLC
DSH180012 Baptist Health Hardin
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Covered Entity Details
Entity Name
Baptist Health Hardin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180012
Entity Address
913 NORTH DIXIE AVENUE
ELIZABETHTOWN, KY 42701
Medicare Provider Number
180012
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Carrico, Chief Operating Officer
(270) 706-5321
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2023
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