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OPTUM PHARMACY 701, LLC
CH040340 RURAL HEALTH CARE, INCORPORATED
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Covered Entity Details
Entity Name
RURAL HEALTH CARE, INCORPORATED
Subdivision Name
AZA HEALTH
Type
HRSA-Funded Health Center
340B ID
CH040340
Entity Address
1302 River St
Palatka, FL 32177-5042
Grant Number
H80CS00081
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
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
Laura M. Spencer, CEO
(386) 328-0108 Ext: 3340
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/15/2025
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