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OPTUM INFUSION SERVICES 500, INC.
HM6415 LUCILE SALTER PACKARD CHILDREN'S HOSPITA
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Covered Entity Details
Entity Name
LUCILE SALTER PACKARD CHILDREN'S HOSPITA
Subdivision Name
HEMOPHILIA PROGRAM
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM6415
Entity Address
725 WELCH ROAD
PALO ALTO, CA 94304
Grant Number
H30MC24045
Participating Start Date
4/1/1996
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
4900 RIVERGRADE RD STE E120
IRWINDALE, CA 91706-1419
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/2/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Rick Stephen Majzun, COO
(650) 723-0418
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2022
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