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OPTUM PHARMACY 806, INC.
DSH460009 University of Utah
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Covered Entity Details
Entity Name
University of Utah
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460009
Entity Address
50 North Medical Drive
Salt Lake City, UT 84132
Medicare Provider Number
460009
Participating Start Date
7/1/1996
Last Recertification Date
8/19/2024
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
10/1/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Gordon Crabtree, CEO
(801) 587-3572
Contract Pharmacy Representative
BriovaRx/Avella
Chris Calagis, VP 340B Sales
(704) 207-4611
Signed By Date
10/1/2019
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