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OPTUM PHARMACY 702, LLC
DSH380047 St. Charles Health System, Inc., d/b/a St. Charles Bend
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Covered Entity Details
Entity Name
St. Charles Health System, Inc., d/b/a St. Charles Bend
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380047
Entity Address
2500 NE NEFF ROAD
BEND, OR 97701
Medicare Provider Number
380047
Participating Start Date
7/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/5/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/5/2020
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