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OPTUM PHARMACY 702, LLC
DSH050043 Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050043
Entity Address
350 HAWTHORNE AVENUE
OAKLAND, CA 94609
Medicare Provider Number
050043
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/18/2023
Contract Begin Date
1/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Iris Wohn, CFO
(510) 869-8620
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/18/2023
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