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OPTUM PHARMACY 702, LLC
DSH150023 UNION HOSPITAL INC.
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Covered Entity Details
Entity Name
UNION HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150023
Entity Address
1606 NORTH SEVENTH ST
TERRE HAUTE, IN 47804
Medicare Provider Number
150023
Participating Start Date
12/28/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt Nealon, Vice President CFO
(812) 238-7606
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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