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OPTUM PHARMACY 702, LLC
CAN050146-00 CITY OF HOPE NATIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CITY OF HOPE NATIONAL MEDICAL CENTER
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050146-00
Entity Address
1500 E. DUARTE ROAD
DUARTE, CA 91010
Medicare Provider Number
050146
Participating Start Date
9/1/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wafa Samara, CPO
(626) 218-4936
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2021
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