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OPTUM PHARMACY 701, LLC
CAH291306-00 Washoe Barton Medical Clinic DBA: Carson Valley Health
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Covered Entity Details
Entity Name
Washoe Barton Medical Clinic DBA: Carson Valley Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH291306-00
Entity Address
1107 Highway 395 North
GARDNERVILLE, NV 89410-7030
Medicare Provider Number
291306
Participating Start Date
1/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeff Prater, CEO
(775) 782-1586
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2022
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