340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 805, INC
CAH031312-00 Bisbee Hospital Association dba Copper Queen Community Hospital
Print
Covered Entity Details
Entity Name
Bisbee Hospital Association dba Copper Queen Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH031312-00
Entity Address
101 Cole Ave
Bisbee, AZ 85603
Medicare Provider Number
031312
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 805, INC
Pharmacy Address
1101 N CENTRAL AVE, STE 102
PHOENIX, AZ 85004-1829
Pharmacy Comments
Contract Details
Approval Date
1/6/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2024
CE terminated due to audit finding
Contacts
Covered Entity Signing Official
Heather A Lundstrom, Chief Financial Officer
(520) 432-6450
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/6/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session