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OPTUM PHARMACY 702, LLC
DSH500016 CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION DBA CONFLUENCE HEALTH HOSPITAL
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Covered Entity Details
Entity Name
CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION DBA CONFLUENCE HEALTH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500016
Entity Address
1201 SOUTH MILLER STREET
WENATCHEE, WA 98801
Medicare Provider Number
500016
Participating Start Date
4/1/2009
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Legel, CFO
(509) 662-1511
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2022
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