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OPTUM PHARMACY 806, INC.
DSH500058 Kadlec Regional Medical Center
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Covered Entity Details
Entity Name
Kadlec Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500058
Entity Address
888 SWIFT BOULEVARD
RICHLAND, WA 99352
Medicare Provider Number
500058
Participating Start Date
7/1/2007
Last Recertification Date
9/5/2024
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
10/15/2020
Contract Begin Date
10/15/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Spencer Dwayne Harris, CFO
(509) 942-2708
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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