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OPTUM PHARMACY 701, LLC
CH053320 SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare
Type
HRSA-Funded Health Center
340B ID
CH053320
Entity Address
2041 Goose Lake Rd,
Sauget, IL 62206-2822
Grant Number
H80CS00195
Participating Start Date
7/1/2001
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/13/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2024
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