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OPTUM PHARMACY 702, LLC
CAH521341-00 THE RICHLAND HOSPITAL INC
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Covered Entity Details
Entity Name
THE RICHLAND HOSPITAL INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521341-00
Entity Address
333 EAST SECOND STREET
RICHLAND CENTER, WI 53581
Medicare Provider Number
521341
Participating Start Date
7/1/2020
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/17/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Richard Puls, Vice President - Clinic Services
(608) 647-6321 Ext: 4125
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/17/2024
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