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OPTUM INFUSION SERVICES 500, INC.
DSH050315 KERN MEDICAL CENTER
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Covered Entity Details
Entity Name
KERN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050315
Entity Address
1700 MT. VERNON AVE.
BAKERSFIELD, CA 93306
Medicare Provider Number
050315
Participating Start Date
10/1/1995
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
4900 RIVERGRADE RD STE E120
IRWINDALE, CA 91706-1419
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Russell V Judd, Chief Executive Officer
(661) 326-2102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
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