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OPTUM PHARMACY 702, LLC
STD15301 Central Outreach Wellness Center, LLC
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Covered Entity Details
Entity Name
Central Outreach Wellness Center, LLC
Subdivision Name
Central Outreach Wellness Center, LLC South Office
Type
Sexually Transmitted Diseases
340B ID
STD15301
Entity Address
817 Jefferson Avenue
Washington, PA 15301
Grant Number
NH25PS005144
Participating Start Date
4/1/2018
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
8/7/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Central Outreach Wellness Center, LLC
Stacy Lane, Owner
(412) 608-8313
Signed By Date
7/14/2020
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