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OPTUM PHARMACY 806, INC.
SCH060013-00 Mercy Regional Medical Center
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Covered Entity Details
Entity Name
Mercy Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060013-00
Entity Address
1010 Three Springs Blvd
Durango, CO 81301
Medicare Provider Number
060013
Participating Start Date
10/1/2013
Last Recertification Date
9/3/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 806, INC.
Pharmacy Address
2288 AUBURN BLVD
STE. 102
SACRAMENTO, CA 95821-1618
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jane Strobel, Chief Financial Officer
(970) 764-3909
Contract Pharmacy Representative
Avella
Tammy Sievert, 340B Implementation and Analytics Manager, Corportate
(602) 769-3073
Signed By Date
7/11/2019
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