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OPTUM PHARMACY 701, LLC
CH102530 INTERNATIONAL COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Subdivision Name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Type
HRSA-Funded Health Center
340B ID
CH102530
Entity Address
720 8TH AVENUE SOUTH
SEATTLE, WA 98104-3033
Grant Number
H80CS00437
Participating Start Date
4/1/1995
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelli Nomura, CEO
(206) 788-3659
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/2/2025
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