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OPTUM PHARMACY 702, LLC
RRC450237-00 CHRISTUS SANTA ROSA HEALTH SYSTEM
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Covered Entity Details
Entity Name
CHRISTUS SANTA ROSA HEALTH SYSTEM
Subdivision Name
CHRISTUS SANTA ROSA HOSPITAL MEDICAL CENTER
Type
Rural Referral Center
340B ID
RRC450237-00
Entity Address
2827 BABCOCK ROAD
SAN ANTONIO, TX 78229
Medicare Provider Number
450237
Participating Start Date
7/1/2018
Last Recertification Date
9/19/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
6/8/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stephanie Parker, VP Finance
(210) 704-3657
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/10/2020
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