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OPTUM INFUSION SERVICES 402, LLC
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 402, LLC
Pharmacy Address
2300 MAIN ST STE 150
IRVINE, CA 92614-6223
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
7/26/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/16/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Darlene Scafiddi, Executive Vice President Chief Operating Officer
(909) 865-9879
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2021
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