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OPTUM PHARMACY 702, LLC
FQHCLA420 COMMUNITY HEALTH CENTERS OF AMERICA
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF AMERICA
Subdivision Name
CHCA Mariposa
Type
Health Center Program Look-Alike
340B ID
FQHCLA420
Entity Address
5320 State Highway 49 N Ste 1
Mariposa, CA 95338-9588
Grant Number
LALCS40180
Participating Start Date
7/1/2024
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/27/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Naresh Channaveerappa, CEO
(209) 678-0990
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/27/2025
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