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OPTUM PHARMACY 701, LLC
CH036640 CHASE BREXTON HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
CHASE BREXTON HEALTH SERVICES, INC
Subdivision Name
Chase Brexton Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH036640
Entity Address
1111 North Charles Street
Baltimore, MD 21201-5505
Grant Number
H80CS00734
Participating Start Date
4/1/1997
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
1/3/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Turnbaugh, CFO
(410) 837-2050 Ext: 1148
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/3/2025
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