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OPTUM PHARMACY 702, LLC
CAH271348-00 Northern Montana Hospital
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Covered Entity Details
Entity Name
Northern Montana Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH271348-00
Entity Address
30 W 13th St
Havre, MT 59501
Medicare Provider Number
271348
Participating Start Date
1/1/2024
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
11/1/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christen Obresley, VP, Regulatory Community Services
(406) 262-1420
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/16/2023
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