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OPTUM PHARMACY 701, LLC
CH080170A PUEBLO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
Colorado Avenue Clinic
Type
HRSA-Funded Health Center
340B ID
CH080170A
Entity Address
300 Colorado Ave
Pueblo, CO 81004-2006
Grant Number
H80CS00692
Participating Start Date
1/1/2000
Last Recertification Date
3/2/2025
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
Donald Moore, CEO
(719) 543-8718 Ext: 139
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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