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OPTUM PHARMACY 701, LLC
DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500054
Entity Address
101 WEST 8TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500054
Participating Start Date
1/1/2005
Last Recertification Date
9/4/2024
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
Shelby D Stokoe, CFO Providence Health Care
(509) 474-4949
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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