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OPTUM PHARMACY 801, INC.
CH090250 CLINICAS DE SALUD DEL PUEBLO,Inc.
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Covered Entity Details
Entity Name
CLINICAS DE SALUD DEL PUEBLO,Inc.
Subdivision Name
Innercare K Street
Type
HRSA-Funded Health Center
340B ID
CH090250
Entity Address
1166 K St
Brawley, CA 92227-2737
Grant Number
H80CS00733
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
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
4/21/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
YVONNE BELL, CEO
(760) 344-9951 Ext: 10102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/21/2021
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