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OPTUM PHARMACY 704, INC.
CH044150 ALBANY AREA PRIMARY HEALTH CARE, INC
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Covered Entity Details
Entity Name
ALBANY AREA PRIMARY HEALTH CARE, INC
Subdivision Name
ALBANY AREA PRIMARY HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH044150
Entity Address
204 N.WESTOVER BLVD.
ALBANY, GA 31707
Grant Number
H80CS00763
Participating Start Date
4/1/2003
Last Recertification Date
2/18/2025
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
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Miquel Bush, Chief Operating Officer
(229) 888-6559 Ext: 6261
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/4/2024
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