340B Drug Pricing Program Database
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OPTUM PHARMACY 702, LLC
DSH150011 MARION GENERAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
MARION GENERAL HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150011
Entity Address
441 NORTH WABASH AVENUE
MARION, IN 46952
Medicare Provider Number
150011
Participating Start Date
7/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TONY ROBERTS, CFO
(765) 660-7041
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/8/2024
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