Contract Pharmacy Details

OPTUM PHARMACY 805, INC
CH090080 MARANA HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MARANA HEALTH CENTER, INC.

Subdivision Name

Marana Health Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH090080

Entity Address

13395 N. Marana Main Street
MARANA, AZ 85653

Grant Number

H80CS00231

Participating Start Date

7/1/1999

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 805, INC

Pharmacy Address

1101 N CENTRAL AVE, STE 102
PHOENIX, AZ 85004-1829

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/7/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Tamie Olson, Chief Financial Officer
(520) 682-4111 Ext: 6221

Contract Pharmacy Representative

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

Signed By Date

7/14/2021

340B Drug Pricing Program Database