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OPTUM PHARMACY 701, LLC
CAH381315-00 ST. ALPHONSUS MEDICAL CENTER BAKER CITY
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Covered Entity Details
Entity Name
ST. ALPHONSUS MEDICAL CENTER BAKER CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381315-00
Entity Address
3325 POCAHONTAS ROAD
BAKER CITY, OR 97814
Medicare Provider Number
381315
Participating Start Date
7/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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