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OPTUM PHARMACY 707, INC
DSH050291 Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
Subdivision Name
dba Sutter Santa Rosa Regional Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050291
Entity Address
30 MARK WEST SPRINGS ROAD
SANTA ROSA, CA 95403
Medicare Provider Number
050291
Participating Start Date
7/1/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 707, INC
Pharmacy Address
4900 RIVERGRADE RD STE E110
IRWINDALE, CA 91706-1401
Pharmacy Comments
Contract Details
Approval Date
1/20/2023
Contract Begin Date
1/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Peterson, CEO Sutter Santa Rosa Regional Hospital
(707) 576-4201
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/20/2023
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