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OPTUM PHARMACY 704, INC.
CH0112230 COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Subdivision Name
CHC'S OF RUTLAND REGION, INC.
Type
HRSA-Funded Health Center
340B ID
CH0112230
Entity Address
275 Route 30 N
Bomoseen, VT 05732-9647
Grant Number
H80CS06659
Participating Start Date
7/1/2006
Last Recertification Date
2/27/2025
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
Michael Gardner, CEO
(802) 855-2083
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2022
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