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OPTUM PHARMACY 701, LLC
DSH040015 MENA REGIONAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
MENA REGIONAL HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040015
Entity Address
311 NORTH MORROW
MENA, AR 71953
Medicare Provider Number
040015
Participating Start Date
7/1/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Ervin, CFO
(479) 243-2130
Contract Pharmacy Representative
Magnolia Regional Medical Center
LeeAnn Scheer, 340B Advisor
(512) 789-8341
Signed By Date
1/15/2025
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