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OPTUM PHARMACY 702, LLC
STD78759 Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78759
Entity Address
8140 N Mopac Expy
Bldg 2
Ste 130
Austin, TX 78759
Grant Number
NH25PS005182
Participating Start Date
10/1/2018
Last Recertification Date
6/1/2023
Entity Termination Date
10/1/2023
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
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Christopher M Hamilton, CEO
(512) 647-6512
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2020
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