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OPTUM PHARMACY 702, LLC
DSH380021 TUALITY HEALTHCARE
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Covered Entity Details
Entity Name
TUALITY HEALTHCARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380021
Entity Address
335 SE 8TH AVE
HILLSBORO, OR 97123
Medicare Provider Number
380021
Participating Start Date
7/1/2010
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/19/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori K James-Nielsen, President
(503) 681-1177
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/19/2020
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