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OPTUM PHARMACY 705, LLC
CAH241329-00 LAKEWOOD HEALTH SYSTEM
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Covered Entity Details
Entity Name
LAKEWOOD HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241329-00
Entity Address
49725 COUNTY 83
STAPLES, MN 56479
Medicare Provider Number
241329
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Thomas Reycraft, CFO
(218) 894-8194
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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