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OPTUM PHARMACY 704, INC.
FQHCLA484 UPTOWN COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
UPTOWN COMMUNITY HEALTH CENTER INC
Subdivision Name
Uptown Community Health Center, Inc. Administration
Type
Health Center Program Look-Alike
340B ID
FQHCLA484
Entity Address
1960 N Ogden St, Ste 300
Denver, CO 80218-3674
Grant Number
LALCS54746
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cherise Callighan, CEO
(303) 318-2505
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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