340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 705, LLC
SCH520088-00 SSM HEALTH ST AGNES HOSPITAL - FOND DU LAC
Print
Covered Entity Details
Entity Name
SSM HEALTH ST AGNES HOSPITAL - FOND DU LAC
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520088-00
Entity Address
430 EAST DIVISION STREET
FOND DU LAC, WI 54935
Medicare Provider Number
520088
Participating Start Date
10/1/2023
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/17/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session