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OPTUM PHARMACY 702, LLC
STD85724 Arizona Board of Regents on Behalf of the University of Arizona Department of Medicine
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Covered Entity Details
Entity Name
Arizona Board of Regents on Behalf of the University of Arizona Department of Medicine
Subdivision Name
Thomas D. Boyer Liver Institute's Hepatitis C Treatment Program
Type
Sexually Transmitted Diseases
340B ID
STD85724
Entity Address
1501 N. Campbell Ave.
Tucson, AZ 85724
Grant Number
NU62PS924550
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Elisha Johnson, Director, Clinical Trials and Contracting
(520) 626-7822
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/20/2020
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