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OPTUM PHARMACY 702, LLC
STD322075 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Jacksonville
Type
Sexually Transmitted Diseases
340B ID
STD322075
Entity Address
4615 Philips Highway
Suite 3
Jacksonville, FL 32207
Grant Number
1 NH25PS005131-01-00
Participating Start Date
7/1/2016
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
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
7/15/2020
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