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OPTUM PHARMACY 702, LLC
DSH050013 St. Helena Hospital, DBA Adventist Health St. Helena
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Covered Entity Details
Entity Name
St. Helena Hospital, DBA Adventist Health St. Helena
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050013
Entity Address
10 WOODLAND ROAD
ST. HELENA, CA 94574
Medicare Provider Number
050013
Participating Start Date
4/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Herber, CEO
(707) 963-6433
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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