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OPTUM PHARMACY 702, LLC
DSH260048 Truman Medical Center, Incorporated dba University Health Truman Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Truman Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260048
Entity Address
2301 Holmes Street
Kansas City, MO 64108
Medicare Provider Number
260048
Participating Start Date
12/1/1992
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lynda Donegan, Vice President/Professional Health Services
(816) 404-3528 Ext: 8164043672
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/16/2017
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