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OPTUM PHARMACY 806, INC.
DSH060013 Mercy Hospital
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Covered Entity Details
Entity Name
Mercy Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060013
Entity Address
1010 THREE SPRINGS BLVD.
DURANGO, CO 81301
Medicare Provider Number
060013
Participating Start Date
1/1/2020
Last Recertification Date
9/10/2024
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
10/21/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Business decision by covered entity and/or pharmacy
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
10/14/2019
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