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OPTUM PHARMACY 705, LLC
CH09311N ALTAMED MEDICAL GROUP
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Covered Entity Details
Entity Name
ALTAMED MEDICAL GROUP
Subdivision Name
AltaMed General Pediatrics @ Children's Hospital
Type
HRSA-Funded Health Center
340B ID
CH09311N
Entity Address
4650 W. SUNSET BLVD.
FIRST FLOOR, PAGE BUILDING
LOS ANGELES, CA 90027
Grant Number
H80CS00142
Participating Start Date
7/1/2008
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
WellPartner
Kristen Danahy, Advisor/Manager, Account Management
(480) 364-2573
Signed By Date
7/3/2024
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