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OPTUM PHARMACY 704, INC.
DSH050108 SUTTER VALLEY HOSPITALS DBA SUTTER MEDICAL CENTER SACRAMENTO
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Covered Entity Details
Entity Name
SUTTER VALLEY HOSPITALS DBA SUTTER MEDICAL CENTER SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050108
Entity Address
2825 Capitol Avenue
SACRAMENTO, CA 95816
Medicare Provider Number
050108
Participating Start Date
4/1/2006
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
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
Timothy J Noakes, CFO
(916) 887-4500
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/20/2023
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