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OPTUM PHARMACY 705, LLC
CAH171350-00 Russell Regional Hospital
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Covered Entity Details
Entity Name
Russell Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171350-00
Entity Address
200 S. Main Street
Russell, KS 67665
Medicare Provider Number
171350
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Paul Caudill, CEO
(785) 483-0708
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/9/2023
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