340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH171387-00 Coffeyville Regional Medical Center
Print
Covered Entity Details
Entity Name
Coffeyville Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171387-00
Entity Address
1400 W 4th St.
Coffeyville, KS 67337
Medicare Provider Number
171387
Participating Start Date
5/13/2024
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
5/13/2024
Contract Begin Date
5/13/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Heath Lawrence, CEO
(620) 252-1519
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/5/2024
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