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OPTUM PHARMACY 701, LLC
CH092880 Lifelong Medical Care
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Covered Entity Details
Entity Name
Lifelong Medical Care
Subdivision Name
LIFELONG MEDICAL CARE
Type
HRSA-Funded Health Center
340B ID
CH092880
Entity Address
2344 6th St
Berkeley, CA 94710-2412
Grant Number
H80CS00808
Participating Start Date
9/9/2005
Last Recertification Date
2/13/2025
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
David Vliet, CEO
(510) 981-4123
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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