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OPTUM PHARMACY 702, LLC
RRC120022-00 STRAUB CLINIC & HOSPITAL
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Covered Entity Details
Entity Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC120022-00
Entity Address
888 S. KING STREET
HONOLULU, HI 96813
Medicare Provider Number
120022
Participating Start Date
1/1/2024
Last Recertification Date
8/21/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/25/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2023
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