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OPTUM PHARMACY 701, LLC
CH103100 UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
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Covered Entity Details
Entity Name
UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
Subdivision Name
Umpqua Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH103100
Entity Address
150 NE Kenneth Ford Drive
Roseburg, OR 97470
Grant Number
H80CS00567
Participating Start Date
10/1/2003
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
4/4/2022
Contract Begin Date
4/4/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leah Woods, Chief Financial Officer
(541) 672-9596 Ext: 120
Contract Pharmacy Representative
Optum
Kevin Hockley, optum
(612) 474-6761
Signed By Date
4/4/2022
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