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OPTUM PHARMACY 801, INC.
CAN050146-00 CITY OF HOPE NATIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CITY OF HOPE NATIONAL MEDICAL CENTER
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050146-00
Entity Address
1500 E. DUARTE ROAD
DUARTE, CA 91010
Medicare Provider Number
050146
Participating Start Date
9/1/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wafa Samara, CPO
(626) 218-4936
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/17/2023
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