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OPTUM PHARMACY 702, LLC
SCH290019-00 CARSON TAHOE REGIONAL HEALTHCARE
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Covered Entity Details
Entity Name
CARSON TAHOE REGIONAL HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH290019-00
Entity Address
1600 MEDICAL PARKWAY
CARSON CITY, NV 89703
Medicare Provider Number
290019
Participating Start Date
1/1/2024
Last Recertification Date
8/14/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
12/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Katie Kucera, Chief Financial Officer
(775) 445-8000 Ext: 5543
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
11/29/2023
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