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OPTUM PHARMACY 702, LLC
STD333171 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
BHW
Type
Sexually Transmitted Diseases
340B ID
STD333171
Entity Address
4101 NORTH WEST 3RD COURT
Medical Plaza
Suite 9
Plantation, FL 33317
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2018
Last Recertification Date
5/27/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/22/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
10/22/2018
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