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OPTUM PHARMACY 702, LLC
DSH250040 SINGING RIVER HEALTH SYSTEM
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Covered Entity Details
Entity Name
SINGING RIVER HEALTH SYSTEM
Subdivision Name
SINGING RIVER HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH250040
Entity Address
2809 DENNY AVENUE
PASCAGOULA, MS 39581
Medicare Provider Number
250040
Participating Start Date
3/15/2022
Last Recertification Date
9/8/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
4/12/2018
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