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OPTUM PHARMACY 701, LLC
CAH171359-00 Greeley County Health Services
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Covered Entity Details
Entity Name
Greeley County Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171359-00
Entity Address
506 Third Street
Tribune, KS 67879
Medicare Provider Number
171359
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
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
Trice Watts, CEO
(620) 376-4221
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/15/2025
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