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OPTUM PHARMACY 806, INC.
CAH381315-00 ST. ALPHONSUS MEDICAL CENTER BAKER CITY
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Covered Entity Details
Entity Name
ST. ALPHONSUS MEDICAL CENTER BAKER CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381315-00
Entity Address
3325 POCAHONTAS ROAD
BAKER CITY, OR 97814
Medicare Provider Number
381315
Participating Start Date
7/1/2011
Last Recertification Date
8/20/2024
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
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/9/2020
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