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OPTUM PHARMACY 705, LLC
CHC11255-00 Stephen F Austin Community Health Center, Inc
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Covered Entity Details
Entity Name
Stephen F Austin Community Health Center, Inc
Subdivision Name
Stephen F Austin
Type
HRSA-Funded Health Center
340B ID
CHC11255-00
Entity Address
1111 W.Adoue St
Alvin, TX 77511-2718
Grant Number
H80CS11255
Participating Start Date
7/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655
Pharmacy Comments
Contract Details
Approval Date
1/13/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Young, CEO
(281) 824-1480
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2024
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