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OPTUM PHARMACY 701, LLC
FQHCLA391 219 HEALTH NETWORK INC
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Covered Entity Details
Entity Name
219 HEALTH NETWORK INC
Subdivision Name
219 Health Network
Type
Health Center Program Look-Alike
340B ID
FQHCLA391
Entity Address
100 W. Chicago Ave. STE F
East Chicago, IN 46312
Grant Number
LALCS32751
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/21/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leo Correa, Administrator and CEO
(219) 392-7004
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/21/2025
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