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OPTUM PHARMACY 704, INC.
CHC28363-00 SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
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Covered Entity Details
Entity Name
SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
Subdivision Name
Longview Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28363-00
Entity Address
409 N. 6th Street
LONGVIEW, TX 75601-6511
Grant Number
H80CS28363
Participating Start Date
7/1/2016
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
8/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Jeanette Geddie, Director of Operations
(903) 212-7159
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
8/1/2024
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