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OPTUM PHARMACY 806, INC.
DSH180143 SAINT JOSEPH EAST
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Covered Entity Details
Entity Name
SAINT JOSEPH EAST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180143
Entity Address
150 NORTH EAGLE CREEK DRIVE
LEXINGTON, KY 40509
Medicare Provider Number
180143
Participating Start Date
1/1/2008
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
7/17/2020
Contract Begin Date
7/17/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lonnie Ralph Taylor, VP Patient Care Services/Operations
(859) 967-5758
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/17/2020
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