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OPTUM PHARMACY 702, LLC
DSH500030 ST. JOSEPH MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500030
Entity Address
2901 SQUALICUM PARKWAY
BELLINGHAM, WA 98225-1851
Medicare Provider Number
500030
Participating Start Date
10/1/2018
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Krista N Touros, CFO
(360) 788-6754 Ext: 6754
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/1/2020
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