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OPTUM PHARMACY 702, LLC
CH050320 COMMUNITY HEALTH SERVICE INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH SERVICE INC.
Subdivision Name
Community Health Service Inc. Moorhead
Type
HRSA-Funded Health Center
340B ID
CH050320
Entity Address
2310 4th Ave N
Moorhead, MN 56560
Grant Number
H80CS00660
Participating Start Date
7/1/1999
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Eastlund, CEO
(507) 206-5756
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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