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OPTUM PHARMACY 701, LLC
FQHCLA358 Equitas Health, Inc.
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Covered Entity Details
Entity Name
Equitas Health, Inc.
Subdivision Name
Equitas Health Short North
Type
Health Center Program Look-Alike
340B ID
FQHCLA358
Entity Address
1033 N High St
Columbus, OH 43201
Grant Number
LALCS31539
Participating Start Date
1/1/2018
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/2/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Nicholas Saltsman, Chief Pharmacy Officer
(614) 987-5621
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/2/2024
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