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OPTUM PHARMACY 704, INC.
CH0627970 AMISTAD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AMISTAD COMMUNITY HEALTH CENTER
Subdivision Name
AMISTAD COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0627970
Entity Address
1533 S Brownlee Blvd
Corpus Christi, TX 78404-3131
Grant Number
H80CS08778
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Talia Peterson, CFO
(325) 374-3638
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/12/2024
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