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OPTUM PHARMACY 705, LLC
CH09013N Sunset Community Health Center
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Covered Entity Details
Entity Name
Sunset Community Health Center
Subdivision Name
Sunset North Yuma Clinic
Type
HRSA-Funded Health Center
340B ID
CH09013N
Entity Address
675 S Avenue B
Building A
Yuma, AZ 85364-2749
Grant Number
H80CS04321
Participating Start Date
1/1/2019
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID D ROGERS, CEO
(928) 819-8802
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/13/2023
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