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OPTUM PHARMACY 707, INC
CAN050660-00 USC Norris Cancer Hospital
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Covered Entity Details
Entity Name
USC Norris Cancer Hospital
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050660-00
Entity Address
1441 Eastlake Avenue
Los Angeles, CA 90033
Medicare Provider Number
050660
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 707, INC
Pharmacy Address
4900 RIVERGRADE RD STE E110
IRWINDALE, CA 91706-1401
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Hanners, Chief Operating Officer
(323) 442-8677
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/14/2020
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