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OPTUM PHARMACY 705, LLC
CHC24167-03 RICHLAND, PARISH OF
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Covered Entity Details
Entity Name
RICHLAND, PARISH OF
Subdivision Name
Delhi Charter School Based Health Center
Type
HRSA-Funded Health Center
340B ID
CHC24167-03
Entity Address
6940 Highway 17
Delhi, LA 71232-7021
Grant Number
H80CS24167
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Barbara Hutchinson, CEO
(318) 878-6650
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/10/2018
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