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OPTUM PHARMACY 704, INC.
CH030850 LINCOLN COUNTY PRIMARY CARE CENTER, INC.
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Covered Entity Details
Entity Name
LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH030850
Entity Address
7400 Lynn Ave
Hamlin, WV 25523-1138
Grant Number
H80CS00254
Participating Start Date
1/1/2004
Last Recertification Date
2/18/2025
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
Lisa King Leach, CEO
(304) 824-5806 Ext: 1236
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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