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OPTUM PHARMACY 701, LLC
CH070300 NORTHEAST MISSOURI HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Subdivision Name
Northeast Missouri Health Council, Inc.
Type
HRSA-Funded Health Center
340B ID
CH070300
Entity Address
1416 Crown Drive
Kirksville, MO 63501
Grant Number
H80CS00731
Participating Start Date
7/1/2004
Last Recertification Date
2/13/2025
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
ANDREW GRIMM, EXECUTIVE DIRECTOR
(660) 627-5757
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/2/2024
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