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OPTUM PHARMACY 702, LLC
CH090160 EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
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Covered Entity Details
Entity Name
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Subdivision Name
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH090160
Entity Address
839 WEST CONGRESS ST
TUCSON, AZ 85745
Grant Number
H80CS00230
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nancy Johnson, CEO
(520) 309-2011
Contract Pharmacy Representative
Optum Rx
Brandy Johnson, 340B National Account Manager
(480) 258-4321
Signed By Date
10/14/2019
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