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OPTUM INFUSION SERVICES 308, LLC
CH107930 KODIAK ISLAND HEALTH CARE FOUNDATION
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Covered Entity Details
Entity Name
KODIAK ISLAND HEALTH CARE FOUNDATION
Subdivision Name
KODIAK COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH107930
Entity Address
1911 E Rezanof Dr
Kodiak, AK 99615-6602
Grant Number
H80CS01445
Participating Start Date
4/1/2004
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 308, LLC
Pharmacy Address
485 N JUNIPER DR
STE 2
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carol Austerman, Executive Director/CEO
(907) 481-5002
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/1/2024
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