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OPTUM PHARMACY 701, LLC
CH043823A BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Melbourne Clinic
Type
HRSA-Funded Health Center
340B ID
CH043823A
Entity Address
17 Silver Palm Avenue
Melbourne, FL 32901-3123
Grant Number
H80CS04213
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/17/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Austin Helton, CEO
(321) 241-6854
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/17/2024
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