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OPTUM PHARMACY 707, INC
CAH061322-00 Salida Hospital District DBA Heart of the Rockies Regional Medical Center
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Covered Entity Details
Entity Name
Salida Hospital District DBA Heart of the Rockies Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061322-00
Entity Address
1000 Rush Drive
Salida, CO 81201
Medicare Provider Number
061322
Participating Start Date
1/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 707, INC
Pharmacy Address
4900 RIVERGRADE RD STE E110
IRWINDALE, CA 91706-1401
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lesley Fagerberg, VP Finance
(719) 530-2213
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/8/2021
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