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OPTUM PHARMACY 702, LLC
DSH190140 FRANKLIN MEDICAL CENTER
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Covered Entity Details
Entity Name
FRANKLIN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190140
Entity Address
2106 LOOP ROAD
WINNSBORO, LA 71295
Medicare Provider Number
190140
Participating Start Date
1/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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
MICHAEL BLAKE KRAMER, CEO
(318) 412-5265
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/9/2023
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