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OPTUM PHARMACY 701, LLC
CHC12858-06 FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES INC
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Covered Entity Details
Entity Name
FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES INC
Subdivision Name
Fedde School Based Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12858-06
Entity Address
21409 Elaine Ave
Hawaiian Gardens, CA 90716-1025
Grant Number
H80CS12858
Participating Start Date
4/1/2024
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
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raquel R. Villa, Chief Executive Officer
(562) 776-5014
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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