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OPTUM PHARMACY 806, INC.
CAH501321-01 NORTH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
NORTH VALLEY HOSPITAL
Subdivision Name
OKANOGAN COUNTY PUBLIC HOSPITAL DIS - Tonasket Family Medical Clinic
Type
Critical Access Hospital
340B ID
CAH501321-01
Entity Address
118 N WHITCOMB AVE
TONASKET, WA 98855-8829
Medicare Provider Number
501321
Outpatient Facility Provider Number
508594
Participating Start Date
7/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 806, INC.
Pharmacy Address
2288 AUBURN BLVD
STE. 102
SACRAMENTO, CA 95821-1618
Pharmacy Comments
Contract Details
Approval Date
7/2/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
John McReynolds, CEO
(509) 486-3128
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/2/2021
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