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OPTUM PHARMACY 702, LLC
STD34952 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD34952
Entity Address
1801 SE Hillmoor Drive
Ste C207
Port St Lucie, FL 34952
Grant Number
NH25PS005131
Participating Start Date
10/1/2018
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2019
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