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OPTUM PHARMACY 702, LLC
CH0627190 FRONTERA HEALTHCARE NETWORK
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Covered Entity Details
Entity Name
FRONTERA HEALTHCARE NETWORK
Subdivision Name
FRONTERA HEALTHCARE NETWORK
Type
HRSA-Funded Health Center
340B ID
CH0627190
Entity Address
604 EAKER STREET
Suite
EDEN, TX 76837
Grant Number
H80CS08225
Participating Start Date
1/1/2008
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cam Kleibrink, CEO
(325) 869-5500
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/11/2024
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