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OPTUM PHARMACY 702, LLC
DSH050280 MERCY MEDICAL CENTER, REDDING
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER, REDDING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050280
Entity Address
2175 ROSALINE AVENUE
REDDING, CA 96001-6009
Medicare Provider Number
050280
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph D'Angina, CFO
(530) 225-6121
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2020
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