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OPTUM PHARMACY 701, LLC
FQHCLA354 ASPIRE HEALTH CENTER
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Covered Entity Details
Entity Name
ASPIRE HEALTH CENTER
Subdivision Name
Aspire Indiana Health - Carmel
Type
Health Center Program Look-Alike
340B ID
FQHCLA354
Entity Address
697 Pro-med Lane
Carmel, IN 46032-5323
Grant Number
LALCS31260
Participating Start Date
1/1/2018
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
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
Kevin Gregory Sheward, Vice President, Strategy & Business Development
(317) 587-0537
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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