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OPTUM PHARMACY 806, INC.
CAH451381-00 MOTHER FRANCES HOSPITAL-WINNSBORO
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Covered Entity Details
Entity Name
MOTHER FRANCES HOSPITAL-WINNSBORO
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451381-00
Entity Address
719 WEST COKE ROAD
WINNSBORO, TX 75494
Medicare Provider Number
451381
Participating Start Date
4/1/2011
Last Recertification Date
8/19/2024
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
4/13/2020
Contract Begin Date
6/8/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Harvey, CEO
(903) 439-4052
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2020
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