Contract Pharmacy Details

OPTUM PHARMACY 806, INC.
DSH130013 Saint Alphonsus Medical Center Nampa

Covered Entity Details

Entity Name

Saint Alphonsus Medical Center Nampa

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH130013

Entity Address

4300 East Flamingo Ave
NAMPA, ID 83687

Medicare Provider Number

130013

Participating Start Date

10/17/2005

Last Recertification Date

8/20/2024

Entity Termination Date

1/1/2025

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

4/8/2020

Contract Begin Date

7/1/2020

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

4/8/2020

340B Drug Pricing Program Database