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OPTUM PHARMACY 702, LLC
DSH500150 LEGACY SALMON CREEK HOSPITAL
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Covered Entity Details
Entity Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500150
Entity Address
2211 NE 139TH ST
VANCOUVER, WA 98686
Medicare Provider Number
500150
Participating Start Date
7/1/2007
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2020
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