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OPTUM PHARMACY 702, LLC
DSH050496 JOHN MUIR MEDICAL CENTER - CONCORD
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Covered Entity Details
Entity Name
JOHN MUIR MEDICAL CENTER - CONCORD
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050496
Entity Address
2540 EAST STREET
CONCORD, CA 94520
Medicare Provider Number
050496
Participating Start Date
1/1/2023
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Pass, Chief Financial Officer
(925) 941-2622
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/6/2023
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