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OPTUM PHARMACY 701, LLC
CAH041308-00 MCGEHEE HOSPITAL INC.
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Covered Entity Details
Entity Name
MCGEHEE HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH041308-00
Entity Address
900 South 3rd
MCGEHEE, AR 71654
Medicare Provider Number
041308
Participating Start Date
10/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Lee Amstutz, CEO
(870) 690-4231 Ext: 4231
Contract Pharmacy Representative
McGehee Hospital, Inc.
Terry Lee Amstutz, CEO
(870) 690-4231 Ext: 4231
Signed By Date
4/10/2025
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