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OPTUM PHARMACY 701, LLC
FQHCLA397 Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Chino Valley Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397
Entity Address
13193 Central Ave STE 100
Chino, CA 91710
Grant Number
LALCS33333
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Cox, Chief Executive Officer
(909) 784-6117
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2023
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