Contract Pharmacy Details

OPTUM PHARMACY 801, INC.
CH068160 HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Waco Family Medicine - Central

Type

HRSA-Funded Health Center

340B ID

CH068160

Entity Address

1600 PROVIDENCE DR
WACO, TX 76707-2261

Grant Number

H80CS00719

Participating Start Date

1/1/2000

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 801, INC.

Pharmacy Address

24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085

Pharmacy Comments

Contract Details

Approval Date

7/10/2020

Contract Begin Date

7/10/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/14/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jackson O Griggs, CEO
(254) 313-4205

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/10/2020

340B Drug Pricing Program Database