340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
DSH490021 CENTRA HEALTH
Print
Covered Entity Details
Entity Name
CENTRA HEALTH
Subdivision Name
Lynchburg General Hospital
Type
Disproportionate Share Hospital
340B ID
DSH490021
Entity Address
1920 ATHERHOLT ROAD
LYNCHBURG, VA 24501
Medicare Provider Number
490021
Participating Start Date
10/1/2023
Last Recertification Date
8/15/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
9/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tabitha M. Culbertson, President, Lynchburg General &Virginia Baptist Hospitals
(434) 200-3014
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/17/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session