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OPTUM PHARMACY 701, LLC
DSH370149 St Anthony Shawnee Hospital
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Covered Entity Details
Entity Name
St Anthony Shawnee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370149
Entity Address
1102 West MacArthur St
SHAWNEE, OK 74804
Medicare Provider Number
370149
Participating Start Date
4/1/2010
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/22/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/22/2024
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