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OPTUM PHARMACY 701, LLC
SCH240044-00 WINONA HEALTH SERVICES
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Covered Entity Details
Entity Name
WINONA HEALTH SERVICES
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240044-00
Entity Address
855 MANKATO AVE
WINONA, MN 55987-0600
Medicare Provider Number
240044
Participating Start Date
4/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Jean Hoeg, Chief Operating Officer of Hospital and Primary Care Services
(507) 453-3789
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/1/2024
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