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OPTUM INFUSION SERVICES 305, LLC
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 305, LLC
Pharmacy Address
15529 COLLEGE BLVD.
LENEXA, KS 66219-1351
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darlene Scafiddi, Executive Vice President Chief Operating Officer
(909) 865-9879
Contract Pharmacy Representative
Optum Rx 340B
Eric Howard, National Account Manager
(503) 601-9663
Signed By Date
10/4/2022
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