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OPTUM PHARMACY 702, LLC
CH043340 CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Family Practice and Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH043340
Entity Address
510 Alston Street
Suite A
Richland, GA 31825-1404
Grant Number
H80CS00393
Participating Start Date
4/1/2002
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/6/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/25/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/6/2018
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