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OPTUM PHARMACY 702, LLC
DSH150065 SCHNECK MEDICAL CENTER
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Covered Entity Details
Entity Name
SCHNECK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150065
Entity Address
411 WEST TIPTON STREET
SEYMOUR, IN 47274
Medicare Provider Number
150065
Participating Start Date
10/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Ridlen, VP Finance/CFO
(812) 522-0170
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/14/2025
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