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OPTUM PHARMACY 702, LLC
RWI20005 MetroHealth
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Covered Entity Details
Entity Name
MetroHealth
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20005
Entity Address
1012 14th Street, NW
Suite 700
Washington, DC 20005
Grant Number
H89HA00012
Participating Start Date
10/1/2019
Last Recertification Date
2/23/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
9/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Miguel McInnis, CEO
(202) 838-9271
Contract Pharmacy Representative
Briova
Joseph L Lovino, Manager, 340B Specialty Program
(412) 445-4495
Signed By Date
9/12/2019
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