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OPTUM PHARMACY 702, LLC
STD39759 West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
STD39759
Entity Address
900 Stark Road
Starkville, MS 39759
Grant Number
NH25PS005147
Participating Start Date
10/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
8/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Billy Kirkpatrick, Chief Executive Officer
(205) 759-8470 Ext: 7
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
8/10/2020
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