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OPTUM PHARMACY 701, LLC
DSH190019 CHRISTUS ST FRANCES CABRINI HOSPITAL
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Covered Entity Details
Entity Name
CHRISTUS ST FRANCES CABRINI HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190019
Entity Address
3330 MASONIC DRIVE
ALEXANDRIA, LA 71301
Medicare Provider Number
190019
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Monte Wilson, CEO
(318) 448-6701
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
10/4/2024
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