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OPTUM PHARMACY 702, LLC
DSH050320 ALAMEDA HEALTH SYSTEM
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Covered Entity Details
Entity Name
ALAMEDA HEALTH SYSTEM
Subdivision Name
HIGHLAND GENERAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH050320
Entity Address
1411 EAST 31ST ST.
OAKLAND, CA 94602
Medicare Provider Number
050320
Participating Start Date
4/1/1995
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
10/22/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Steven Fratzke, Interim COO
(510) 535-7631
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/22/2021
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