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OPTUM PHARMACY 701, LLC
CH100460 COLUMBIA BASIN HEALTH ASSOCIATION
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Covered Entity Details
Entity Name
COLUMBIA BASIN HEALTH ASSOCIATION
Subdivision Name
OTHELLO CLINIC
Type
HRSA-Funded Health Center
340B ID
CH100460
Entity Address
1515 E. Columbia St.
Othello, WA 99344-1040
Grant Number
H80CS00147
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
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
Nieves Gomez, Chief Executive Officer
(509) 488-5256
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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