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OPTUM PHARMACY 701, LLC
STD72114 Pinnacle Health Partners, PLLC
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Covered Entity Details
Entity Name
Pinnacle Health Partners, PLLC
Subdivision Name
Diversity Family Health
Type
Sexually Transmitted Diseases
340B ID
STD72114
Entity Address
500 South University
Suite 711
AR
Little Rock, AR 72205
Grant Number
NH25PS0051320505
Participating Start Date
10/1/2023
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Ryan Rooms, Director
(405) 848-0026
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/15/2025
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