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OPTUM PHARMACY 801, INC.
RRC070034-00 NORWALK HOSPITAL
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Covered Entity Details
Entity Name
NORWALK HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070034-00
Entity Address
MAPLE ST
NORWALK, CT 06856
Medicare Provider Number
070034
Participating Start Date
7/1/2024
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karen Steele, VP Pharmacy Services
(845) 472-9571
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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