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OPTUM INFUSION SERVICES 402, LLC
DSH050128 TRI-CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
TRI-CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050128
Entity Address
4002 VISTA WAY
OCEANSIDE, CA 92056-4506
Medicare Provider Number
050128
Participating Start Date
1/1/2019
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 402, LLC
Pharmacy Address
2300 MAIN ST STE 150
IRVINE, CA 92614-6223
Pharmacy Comments
Contract Details
Approval Date
4/18/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Janice Gurley, Chief Financial Officer
(760) 940-5605
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2024
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