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OPTUM PHARMACY 701, LLC
STD20017 Washington Health Institute
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Covered Entity Details
Entity Name
Washington Health Institute
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD20017
Entity Address
1140 Varnum Street NE
PMB; Suite # 203
Washington, DC 20017-2153
Grant Number
1NH25PS005133-01-00
Participating Start Date
7/1/2019
Last Recertification Date
5/7/2024
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
Jose Bordon, Chief Executive Officer
(240) 426-8890
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2025
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