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OPTUM PHARMACY 701, LLC
RWII78759A Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Ryan White Part B
340B ID
RWII78759A
Entity Address
2800 S. IH-35
Austin, TX 78704
Grant Number
X07 - HA00054
Participating Start Date
10/1/2019
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/19/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Adams, CFO
(512) 643-8770
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/19/2025
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