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OPTUM PHARMACY 805, INC
STD850153 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
AZ Suite 6
Type
Sexually Transmitted Diseases
340B ID
STD850153
Entity Address
4350 N 19th Avenue
Suite 6
Phoenix, AZ 85015
Grant Number
6 NU62PS924818-01-01
Participating Start Date
1/1/2020
Last Recertification Date
5/28/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 805, INC
Pharmacy Address
1101 N CENTRAL AVE, STE 102
PHOENIX, AZ 85004-1829
Pharmacy Comments
Contract Details
Approval Date
1/22/2020
Contract Begin Date
4/1/2020
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
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/22/2020
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