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OPTUM PHARMACY 701, LLC
DSH050195 WASHINGTON HOSPITAL HEALTHCARE SYSTEM
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Covered Entity Details
Entity Name
WASHINGTON HOSPITAL HEALTHCARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050195
Entity Address
2000 MOWRY AVENUE
FREMONT, CA 94538
Medicare Provider Number
050195
Participating Start Date
7/1/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry LaBossiere, SVP & COO
(510) 818-6586
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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