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OPTUM PHARMACY 701, LLC
CH045800 GOSHEN MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
GOSHEN MEDICAL CENTER, INC.
Subdivision Name
GOSHEN MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH045800
Entity Address
444 SW Center St
Faison, NC 28341
Grant Number
H80CS00181
Participating Start Date
7/1/2003
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/23/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Barwick, Deputy CEO
(910) 267-1942
Contract Pharmacy Representative
Optum
Judith Fox, Sr Client Relationship Manager
(413) 348-3637
Signed By Date
10/23/2024
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