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AETNA SPECIALTY PHARMACY, LLC
CH091540 OPEN DOOR COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
OPEN DOOR COMMUNITY HEALTH CENTERS
Subdivision Name
Arcata Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH091540
Entity Address
1150 Foster Avenue
Arcata, CA 95521-6210
Grant Number
H80CS00225
Participating Start Date
7/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
AETNA SPECIALTY PHARMACY, LLC
Pharmacy Address
503 SUNPORT LN
ORLANDO, FL 32809-7874
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Bella, CFO
(707) 826-8633 Ext: 5146
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
7/11/2019
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