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OPTUM PHARMACY 701, LLC
CH021790 HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Hudson Headwaters Administrative Offices
Type
HRSA-Funded Health Center
340B ID
CH021790
Entity Address
9 CAREY ROAD
QUEENSBURY, NY 12804
Grant Number
H80CS00159
Participating Start Date
4/1/2001
Last Recertification Date
2/10/2025
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
Laura Pasco, EVP, Chief Financial Officer
(518) 761-0300 Ext: 31553
Contract Pharmacy Representative
Optum
Jeff Noone, National Account Manager
(412) 973-2453
Signed By Date
7/16/2024
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