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OPTUM PHARMACY 700, LLC
CH043823L BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Malabar Clinic
Type
HRSA-Funded Health Center
340B ID
CH043823L
Entity Address
775 Malabar Rd
Malabar, FL 32950-3120
Grant Number
H80CS04213
Participating Start Date
4/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
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
Austin Helton, CEO
(321) 241-6854
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2025
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