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OPTUM PHARMACY 702, LLC
CH0910250 MENDOCINO COAST CLINICS, INC.
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Covered Entity Details
Entity Name
MENDOCINO COAST CLINICS, INC.
Subdivision Name
MENDOCINO COAST CLINICS, INC.
Type
HRSA-Funded Health Center
340B ID
CH0910250
Entity Address
205 South St
Fort Bragg, CA 95437-5540
Grant Number
H80CS00876
Participating Start Date
1/1/2001
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
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucresha Renteria, Executive Director
(707) 964-1251 Ext: 3433
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/3/2024
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