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OPTUM PHARMACY 803, INC.
CAH291306-00 Washoe Barton Medical Clinic DBA: Carson Valley Health
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Covered Entity Details
Entity Name
Washoe Barton Medical Clinic DBA: Carson Valley Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH291306-00
Entity Address
1107 Highway 395 North
GARDNERVILLE, NV 89410-7030
Medicare Provider Number
291306
Participating Start Date
1/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 803, INC.
Pharmacy Address
701 SHADOW LN #110
LAS VEGAS, NV 89106-4132
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/4/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Preston Becker, CEO
(775) 782-1507
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
1/15/2018
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