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OPTUM PHARMACY 702, LLC
DSH050159AF VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Santa Paula Hospital - Emergency Services - Emergency Services
Type
Disproportionate Share Hospital
340B ID
DSH050159AF
Entity Address
825 North 10th St.
RM 152
Santa Paula, CA 93060-1309
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
10/1/2020
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Fankhauser, Chief Executive Officer
(805) 652-6058
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2022
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