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OPTUM PHARMACY 704, INC.
CHC11298-00 TRAVIS COUNTY HEALTHCARE DISTRICT
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Covered Entity Details
Entity Name
TRAVIS COUNTY HEALTHCARE DISTRICT
Subdivision Name
CommUnityCare Kramer Administrative Offices
Type
HRSA-Funded Health Center
340B ID
CHC11298-00
Entity Address
2115 KRAMER LN
STE 100
Austin, TX 78758
Grant Number
H80CS11298
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
10/20/2020
Contract Begin Date
10/28/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jaeson Fournier, CEO
(512) 978-9050 Ext: 5125954337
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/20/2020
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