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OPTUM PHARMACY 702, LLC
DSH180080 BAPTIST HEALTH CORBIN
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Covered Entity Details
Entity Name
BAPTIST HEALTH CORBIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180080
Entity Address
1 TRILLIUM WAY
CORBIN, KY 40701
Medicare Provider Number
180080
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Powers, COO
(606) 523-8626
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2023
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