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OPTUM PHARMACY 704, INC.
CH068160 HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
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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 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
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
10/14/2021
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