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OPTUM PHARMACY 702, LLC
DSH050030 OROVILLE HOSPITAL
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Covered Entity Details
Entity Name
OROVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050030
Entity Address
2767 OLIVE HIGHWAY
OROVILLE, CA 95966
Medicare Provider Number
050030
Participating Start Date
7/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Colleen Sue Duncan, Chief Financial Officer
(530) 532-8603
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/6/2020
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