340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH451319-00 MOTHER FRANCES HOSPITAL-JACKSONVILLE
Print
Covered Entity Details
Entity Name
MOTHER FRANCES HOSPITAL-JACKSONVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451319-00
Entity Address
2026 S.JACKSON ST.
JACKSONVILLE, TX 75766
Medicare Provider Number
451319
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
8/1/2024
Contract Begin Date
8/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry D. Lofquist, Administrator
(903) 541-4505
Contract Pharmacy Representative
Optum
Shehan Welihindha, National Account Manager
(916) 233-7775
Signed By Date
8/1/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session