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OPTUM PHARMACY 702, LLC
SCH330235-00 AUBURN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
AUBURN COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330235-00
Entity Address
17 LANSING STREET
AUBURN, NY 13021
Medicare Provider Number
330235
Participating Start Date
10/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Burch, Senior Vice President of Administration
(315) 567-0560
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2023
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