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OPTUM PHARMACY 702, LLC
CHC33644-00 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Subdivision Name
Valleywise Health Administrative Building
Type
HRSA-Funded Health Center
340B ID
CHC33644-00
Entity Address
2601 E Roosevelt St
Phoenix, AZ 85008
Grant Number
H80CS33644
Participating Start Date
1/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
1/10/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/14/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Mutarelli, Executive Vice President, Chief Financial Officer
(602) 344-8425
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
1/10/2020
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