Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
RWI75219 Resource Center of Dallas

Covered Entity Details

Entity Name

Resource Center of Dallas

Subdivision Name

Type

Ryan White Part A

340B ID

RWI75219

Entity Address

2701 Reagan Street
Dallas, TX 75219

Grant Number

H89HA00002

Participating Start Date

7/1/2015

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

7/5/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Marisa Elliott, Chief Operating Officer
(214) 540-4454

Contract Pharmacy Representative

CVS Health
Christian Reid, 340B Program Director
(401) 770-2118

Signed By Date

7/5/2023

340B Drug Pricing Program Database