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OPTUM PHARMACY 704, INC.
STD37403 CHATTANOOGA C.A.R.E.S. DBA CEMPA COMMUNITY CARE
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Covered Entity Details
Entity Name
CHATTANOOGA C.A.R.E.S. DBA CEMPA COMMUNITY CARE
Subdivision Name
CHATTANOOGA PRIMARY CARE CENTER
Type
Sexually Transmitted Diseases
340B ID
STD37403
Entity Address
1000 E. 3rd Street
Suite 300
Chattanooga, TN 37403
Grant Number
NU65PS923764
Participating Start Date
7/1/2016
Last Recertification Date
5/7/2025
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
4/18/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shannon Stephenson, CEO
(423) 648-9911
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2021
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