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OPTUM PHARMACY 801, INC.
CH09287H CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Subdivision Name
Chiricahua Community Health Centers, Inc. Sierra Vista Adult Clinic
Type
HRSA-Funded Health Center
340B ID
CH09287H
Entity Address
155 Calle Portal Ste 300
Sierra Vista, AZ 85635-2900
Grant Number
H80CS00696
Participating Start Date
1/1/2016
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Melk, CEO
(520) 227-9167
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2023
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