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OPTUM PHARMACY 702, LLC
STD9812231 Gay City Health Project
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Covered Entity Details
Entity Name
Gay City Health Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD9812231
Entity Address
400 E Pine St
100
Seattle, WA 98122
Grant Number
NU62PS924528
Participating Start Date
7/1/2020
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
10/20/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fred Swanson, Executive Director
(206) 388-1702
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/6/2020
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