Contract Pharmacy Details

OPTUM PHARMACY 806, INC.
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

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

7/12/2020

Contract Begin Date

7/12/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/18/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Chad Thurman Lefteris, CEO
(714) 714-1423

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677

Signed By Date

7/12/2020

340B Drug Pricing Program Database