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OPTUM PHARMACY 702, LLC
DSH440111 METRO NASHVILLE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
METRO NASHVILLE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440111
Entity Address
1818 ALBION STREET
NASHVILLE, TN 37208
Medicare Provider Number
440111
Participating Start Date
10/1/2001
Last Recertification Date
9/10/2024
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
Mark Brown, COO
(615) 341-4461
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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