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OPTUM PHARMACY 702, LLC
DSH050047 SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
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Covered Entity Details
Entity Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER PACIFIC CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050047
Entity Address
1101 VAN NESS AVE
SAN FRANCISCO, CA 94109
Medicare Provider Number
050047
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/24/2023
Contract Begin Date
1/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
HENRY YU, VP AND CFO
(415) 600-3850
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/24/2023
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