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OPTUM PHARMACY 702, LLC
DSH050334 SALINAS VALLEY HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
SALINAS VALLEY HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050334
Entity Address
450 EAST ROMIE LANE
SALINAS, CA 93901
Medicare Provider Number
050334
Participating Start Date
10/1/2009
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pete Delgado, CEO
(831) 755-0741
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2020
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