Contract Pharmacy Details

OPTUM PHARMACY 801, INC.
FQHCLA397B Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Health Service Alliance

Type

Health Center Program Look-Alike

340B ID

FQHCLA397B

Entity Address

9804 Foothill Blvd
Rancho Cucamonga, CA 91730-3616

Grant Number

LALCS33333

Participating Start Date

10/1/2021

Last Recertification Date

2/11/2025

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

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

340B Drug Pricing Program Database