340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH381303-00 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Print
Covered Entity Details
Entity Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381303-00
Entity Address
725 S. WAHANNA RD.
SEASIDE, OR 97138-7735
Medicare Provider Number
381303
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Jill Cooper, Director of Finance
(503) 717-2241
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
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