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OPTUM PHARMACY 702, LLC
SCH050335-00 ADVENTIST HEALTH SONORA
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Covered Entity Details
Entity Name
ADVENTIST HEALTH SONORA
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050335-00
Entity Address
1000 GREENLEY ROAD
SONORA, CA 95370
Medicare Provider Number
050335
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Greg McCulloch, President
(209) 536-5012
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/11/2024
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