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OPTUM PHARMACY 702, LLC
CHC24167-02 RICHLAND, PARISH OF
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Covered Entity Details
Entity Name
RICHLAND, PARISH OF
Subdivision Name
Delhi Middle School SBHC
Type
HRSA-Funded Health Center
340B ID
CHC24167-02
Entity Address
106 Toombs St
Delhi, LA 71232-2647
Grant Number
H80CS24167
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Barbara Hutchinson, CEO
(318) 878-6650
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/10/2018
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