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OPTUM PHARMACY 702, LLC
CAH501321-00 NORTH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
NORTH VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501321-00
Entity Address
203 SOUTH WESTERN
TONASKET, WA 98855
Medicare Provider Number
501321
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
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
7/8/2021
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