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OPTUM PHARMACY 702, LLC
DSH120022 STRAUB CLINIC & HOSPITAL
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Covered Entity Details
Entity Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120022
Entity Address
888 S. KING STREET
HONOLULU, HI 96813
Medicare Provider Number
120022
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/26/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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