Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
CH0928870 CHINATOWN SERVICE CENTER

Covered Entity Details

Entity Name

CHINATOWN SERVICE CENTER

Subdivision Name

CHINATOWN SERVICE CENTER - COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH0928870

Entity Address

767 N. Hill Street
Suite 200
Los Angeles, CA 90012-2343

Grant Number

H80CS08735

Participating Start Date

10/1/2004

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

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

Peter Ng, CEO
(213) 808-1701

Contract Pharmacy Representative

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

Signed By Date

4/15/2025

340B Drug Pricing Program Database