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OPTUM PHARMACY 702, LLC
CAH271344-00 SIDNEY HEALTH CENTER
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Covered Entity Details
Entity Name
SIDNEY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271344-00
Entity Address
216 14TH AVE SW
SIDNEY, MT 59270
Medicare Provider Number
271344
Participating Start Date
9/15/2010
Last Recertification Date
8/20/2024
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
Tina Montgomery, CFO
(406) 488-2117
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
10/9/2023
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