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OPTUM PHARMACY 704, INC.
CH050640 Family Health Services of Darke County
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Covered Entity Details
Entity Name
Family Health Services of Darke County
Subdivision Name
FAMILY HEALTH SERVICES OF DARKE COUNTY
Type
HRSA-Funded Health Center
340B ID
CH050640
Entity Address
5735 Meeker Rd
Greenville, OH 45331-1180
Grant Number
H80CS00419
Participating Start Date
4/1/2001
Last Recertification Date
2/17/2025
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
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Pollick, Executive Director
(937) 548-3806
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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