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OPTUM PHARMACY 702, LLC
DSH050127 WOODLAND MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
WOODLAND MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050127
Entity Address
1325 COTTONWOOD ST
WOODLAND, CA 95695
Medicare Provider Number
050127
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph D'Angina, CFO
(530) 225-6121
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/11/2019
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