Contract Pharmacy Details

OPTUMRX
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

OPTUMRX

Pharmacy Address

2858 LOKER AVE E STE 100
CARLSBAD, CA 92010-6608

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/27/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

1/14/2020

340B Drug Pricing Program Database