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OPTUM PHARMACY 702, LLC
CAH281354-00 CRETE AREA MEDICAL CENTER
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Covered Entity Details
Entity Name
CRETE AREA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281354-00
Entity Address
2910 BETTEN DRIVE
CRETE, NE 68333
Medicare Provider Number
281354
Participating Start Date
1/1/2012
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
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Boldt, President/CEO
(402) 826-7997
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/16/2023
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