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OPTUM PHARMACY 701, LLC
CH101000 MOSES LAKE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
MOSES LAKE COMMUNITY HEALTH CENTER
Subdivision Name
MOSES LAKE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH101000
Entity Address
605 S Coolidge St
Moses Lake, WA 98837
Grant Number
H80CS00702
Participating Start Date
1/1/2000
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
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sheila Berschauer, CEO
(509) 765-0674 Ext: 2411
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/15/2025
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