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OPTUM PHARMACY 707, INC
DSH450034 CHRISTUS HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450034
Entity Address
2830 CALDER STREET
BEAUMONT, TX 77702-1048
Medicare Provider Number
450034
Participating Start Date
5/25/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 707, INC
Pharmacy Address
4900 RIVERGRADE RD STE E110
IRWINDALE, CA 91706-1401
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
5/28/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Trevino, CEO, CHRISTUS Health Southeast Texas
(409) 899-7102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/6/2021
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