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OPTUM PHARMACY 704, INC.
CH0614350 COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
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Covered Entity Details
Entity Name
COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Subdivision Name
COMMUNITY ACTION CORPORATION OF SOUTH TEXAS
Type
HRSA-Funded Health Center
340B ID
CH0614350
Entity Address
204 E 1st St
Alice, TX 78332-4822
Grant Number
H80CS02323
Participating Start Date
4/1/2004
Last Recertification Date
2/14/2025
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
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Awalt, CEO
(361) 664-0145 Ext: 2024
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2022
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