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OPTUM PHARMACY 806, INC.
DSH050045 EL CENTRO REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
EL CENTRO REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050045
Entity Address
1415 ROSS AVENUE
EL CENTRO, CA 92243
Medicare Provider Number
050045
Participating Start Date
10/1/2006
Last Recertification Date
8/12/2024
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
7/6/2020
Contract Begin Date
7/6/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/18/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Cathy Kennerson, Chief Strategic Officer
(760) 339-7107
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/6/2020
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