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OPTUM PHARMACY 801, INC.
DSH050441 STANFORD HEALTH CARE
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Covered Entity Details
Entity Name
STANFORD HEALTH CARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050441
Entity Address
300 PASTEUR DRIVE
Stanford, CA 94305
Medicare Provider Number
050441
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
7/8/2020
Contract Begin Date
7/8/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Linda Hoff, CFO
(650) 497-0391
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/8/2020
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