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OPTUM PHARMACY 702, LLC
CH06374F NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
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Covered Entity Details
Entity Name
NORTH CENTRAL TEXAS COMMUNITY HEALTH CARE CENTER
Subdivision Name
Pediatric Associates
Type
HRSA-Funded Health Center
340B ID
CH06374F
Entity Address
4420 Kimbell Drive
Wichita Falls, TX 76302-3006
Grant Number
H80CS00553
Participating Start Date
4/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allen Patterson, CEO
(940) 397-2602
Contract Pharmacy Representative
Optum
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
4/4/2024
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