Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
RWII342371K CAN Community Health, Inc.

Covered Entity Details

Entity Name

CAN Community Health, Inc.

Subdivision Name

Pensacola

Type

Ryan White Part B

340B ID

RWII342371K

Entity Address

8390 N Palafox St.
Pensacola, FL 32534

Grant Number

X07HA00057

Participating Start Date

7/1/2020

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

10/13/2020

Contract Begin Date

1/1/2021

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

10/13/2020

340B Drug Pricing Program Database