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OPTUM PHARMACY 701, LLC
CAH151330-00 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151330-00
Entity Address
1100 MERCER AVE
DECATUR, IN 46733-0151
Medicare Provider Number
151330
Participating Start Date
9/14/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Smith, Executive Director
(260) 724-2145 Ext: 11002
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/11/2024
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