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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 W 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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