Contract Pharmacy Details

OPTUM INFUSION SERVICES 101, INC.
CH027260 REFUAH HEALTH CENTER, INC.

Covered Entity Details

Entity Name

REFUAH HEALTH CENTER, INC.

Subdivision Name

REFUAH HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH027260

Entity Address

728 N MAIN ST
SPRING VALLEY, NY 10977

Grant Number

H80CS00281

Participating Start Date

7/1/2004

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 101, INC.

Pharmacy Address

931 CONKLIN ST STE D
FARMINGDALE, NY 11735-2429

Pharmacy Comments

Contract Details

Approval Date

4/8/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Amanda Christina Salzman, Director of Public Affairs and Grants Administration
(620) 262-5550

Contract Pharmacy Representative

Optum
Avani Patel, VP, 340B Operations
(763) 330-5555

Signed By Date

4/8/2025

340B Drug Pricing Program Database