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OPTUM INFUSION SERVICES 305, LLC
CAH191317-00 JACKSON PARISH HOSPITAL
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Covered Entity Details
Entity Name
JACKSON PARISH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191317-00
Entity Address
165 BEECH SPRINGS ROAD
JONESBORO, LA 71251
Medicare Provider Number
191317
Participating Start Date
10/1/2018
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 305, LLC
Pharmacy Address
11211 INDUSTRIPLEX BLVD STE 900
BATON ROUGE, LA 70809-4178
Pharmacy Comments
Contract Details
Approval Date
4/25/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Morgan, CEO
(318) 259-4435
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/25/2024
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