Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
CH047000 HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.

Covered Entity Details

Entity Name

HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.

Subdivision Name

Health Care Partners of South Carolina, Inc. - Conway Administrative Office

Type

HRSA-Funded Health Center

340B ID

CH047000

Entity Address

1708 Oak Street
Conway, SC 29526-3086

Grant Number

H80CS00411

Participating Start Date

12/1/1992

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 701, LLC

Pharmacy Address

1830 S HORNE
MESA, AZ 85204

Pharmacy Comments

Contract Details

Approval Date

7/16/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Santina Mayo, Chief Executive Officer
(843) 488-6034

Contract Pharmacy Representative

Optum
Avani Patel, VP, 340B Operations
(763) 330-5555

Signed By Date

7/16/2024

340B Drug Pricing Program Database