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OPTUM PHARMACY 702, LLC
STD787021 CHE Center for Health Empowerment
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Covered Entity Details
Entity Name
CHE Center for Health Empowerment
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD787021
Entity Address
2312 Western Trails Blvd
Ste 103
Austin, TX 78745
Grant Number
NH25PS005182
Participating Start Date
7/1/2017
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/17/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Valerie Agee, Chief Operations Officer
(512) 840-1273
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/16/2018
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