Contract Pharmacy Details

OPTUM PHARMACY 705, LLC
FQHCLA397E Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Palm Desert Community Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA397E

Entity Address

41990 Cook St STE F-2002
Palm Desert, CA 92211-6100

Grant Number

LALCS33333

Participating Start Date

10/1/2023

Last Recertification Date

3/6/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 705, LLC

Pharmacy Address

1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298

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

Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2025

340B Drug Pricing Program Database