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OPTUM PHARMACY 701, LLC
CH024490 NORTH HUDSON COMMUNITY ACTION CORPORATION
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Covered Entity Details
Entity Name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Subdivision Name
North Hudson Community Action Corporation @ West New York
Type
HRSA-Funded Health Center
340B ID
CH024490
Entity Address
5301 BROADWAY
WEST NEW YORK, NJ 07093-2622
Grant Number
H80CS00521
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
4/25/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Acosta, Executive Vice President
(201) 210-0100 Ext: 10102
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/25/2025
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