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OPTUM PHARMACY 800, INC.
CH049100 NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Subdivision Name
Benton Medical Center
Type
HRSA-Funded Health Center
340B ID
CH049100
Entity Address
15921 Boundary Dr
Ashland, MS 38603-7740
Grant Number
H80CS00635
Participating Start Date
9/9/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 800, INC.
Pharmacy Address
3016 GUADALUPE ST STE A
AUSTIN, TX 78705-2861
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES D. NUNNALLY, EXECUTIVE DIRECTOR
(662) 224-8951 Ext: 230
Contract Pharmacy Representative
Avella
Tammy Sievert, 340B Implementation and Analytics Manager, Corportate
(602) 769-3073
Signed By Date
4/14/2017
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