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OPTUM PHARMACY 806, INC.
DSH200039 MAINEGENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200039
Entity Address
35 Medical Center Parkway
Augusta, ME 04330
Medicare Provider Number
200039
Participating Start Date
7/1/2008
Last Recertification Date
8/19/2024
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
7/13/2020
Contract Begin Date
9/9/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Terrance Brann, Chief Financial Officer
(207) 623-6624
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2020
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