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OPTUM PHARMACY 806, INC.
CAH051328-00 TAHOE FOREST HOSPITAL
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Covered Entity Details
Entity Name
TAHOE FOREST HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051328-00
Entity Address
10121 PINE AVENUE
TRUCKEE, CA 96161
Medicare Provider Number
051328
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
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
7/15/2020
Contract Begin Date
7/15/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/28/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
CRYSTAL BETTS, CHIEF FINANCIAL OFFICER
(530) 582-6656
Contract Pharmacy Representative
TAHOE FOREST HOSPITAL DISTRICT
TENA MATHER, DIRECTOR OF PHARMACY
(530) 582-6465
Signed By Date
7/15/2020
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