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OPTUM PHARMACY 702, LLC
DSH050159 VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050159
Entity Address
300 HILLMONT AVE
VENTURA, CA 93003
Medicare Provider Number
050159
Participating Start Date
12/1/1992
Last Recertification Date
9/5/2024
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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