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OPTUM PHARMACY 701, LLC
RWI06702 StayWell Health Care Inc.
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Covered Entity Details
Entity Name
StayWell Health Care Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI06702
Entity Address
80 Phoenix Ave
201
Waterbury, CT 06702
Grant Number
H89HA00029
Participating Start Date
1/1/2018
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Thompson, CEO
(203) 756-8021 Ext: 3016
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/14/2024
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