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OPTUM PHARMACY 806, INC.
DSH050438 HUNTINGTON HOSPITAL
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Covered Entity Details
Entity Name
HUNTINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050438
Entity Address
100 W. California Blvd
Pasadena, CA 91105
Medicare Provider Number
050438
Participating Start Date
7/1/2019
Last Recertification Date
8/30/2024
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
5/18/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Steven Mohr, Senior Vice President & Chief Financial Officer
(626) 397-5555
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
5/18/2020
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