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OPTUM PHARMACY 701, LLC
CAH431337-00 AVERA HAND COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
AVERA HAND COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431337-00
Entity Address
300 W 5TH ST
MILLER, SD 57362
Medicare Provider Number
431337
Participating Start Date
9/30/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
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
Melissa Goff, Vice President - Pharmacy
(605) 322-8548
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/14/2025
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