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OPTUM PHARMACY 702, LLC
CAH351332-00 Heart of America Medical Center
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Covered Entity Details
Entity Name
Heart of America Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351332-00
Entity Address
2975 Hwy 2 East
Rugby, ND 58368
Medicare Provider Number
351332
Participating Start Date
10/1/2012
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/16/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erik Christenson, CEO
(701) 776-5455 Ext: 2241
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/16/2024
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