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OPTUM PHARMACY 701, LLC
SCH520037-00 MARSHFIELD MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHFIELD MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH520037-00
Entity Address
611 ST JOSEPH AVENUE
MARSHFIELD, WI 54449
Medicare Provider Number
520037
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Chaloner, President
(715) 387-7855
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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