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OPTUM PHARMACY 701, LLC
CH051833A Heartland Community Health Clinic DBA: Heartland Health Services
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Covered Entity Details
Entity Name
Heartland Community Health Clinic DBA: Heartland Health Services
Subdivision Name
Garden
Type
HRSA-Funded Health Center
340B ID
CH051833A
Entity Address
1701 W Garden St
Peoria, IL 61605
Grant Number
H80CS02457
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dewitt Harrell, CEO
(309) 680-7657
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/14/2025
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