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OPTUM PHARMACY 701, LLC
CHC26564-03 SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Subdivision Name
Four Rivers Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26564-03
Entity Address
1081 E 18th St
Rolla, MO 65401
Grant Number
H80CS26564
Participating Start Date
1/1/2017
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/16/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Hunter Gipson, CEO
(417) 576-7273
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/16/2024
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