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OPTUM PHARMACY 705, LLC
DSH050590 METHODIST HOSPITAL OF SACRAMENTO
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Covered Entity Details
Entity Name
METHODIST HOSPITAL OF SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050590
Entity Address
7500 HOSPITAL DRIVE
SACRAMENTO, CA 95823
Medicare Provider Number
050590
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
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
Eric Hodes, CMO
(916) 423-6023
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
10/15/2019
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