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OPTUM PHARMACY 806, INC.
DSH070006 THE STAMFORD HOSPITAL
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Covered Entity Details
Entity Name
THE STAMFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070006
Entity Address
One Hospital Plaza
STAMFORD, CT 06902
Medicare Provider Number
070006
Participating Start Date
7/1/2016
Last Recertification Date
8/23/2024
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
7/14/2020
Contract Begin Date
7/14/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ellen Komar, CNO & Sr VP -Patient Services
(203) 276-7401 Ext: 7401
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2020
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