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OPTUM PHARMACY 701, LLC
RRC050145-00 COMMUNITY HOSP. MONTEREY PENINSULA
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Covered Entity Details
Entity Name
COMMUNITY HOSP. MONTEREY PENINSULA
Subdivision Name
Type
Rural Referral Center
340B ID
RRC050145-00
Entity Address
23625 HOLMAN HWY
MONTEREY, CA 93940
Medicare Provider Number
050145
Participating Start Date
4/1/2024
Last Recertification Date
9/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Thomas Morgan, CFO
(831) 625-4965
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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