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OPTUM PHARMACY 702, LLC
STD328061 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Orlando
Type
Sexually Transmitted Diseases
340B ID
STD328061
Entity Address
1301 W Colonial Drive
Orlando, FL 32804
Grant Number
1 NH25PS005131-01-00
Participating Start Date
4/5/2019
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/5/2019
Contract Begin Date
4/8/2019
Carve-In Effective Date
Contract Comments
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
4/5/2019
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