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OPTUM PHARMACY 702, LLC
STD336171 CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Temple Terrace
Type
Sexually Transmitted Diseases
340B ID
STD336171
Entity Address
341 Bullard Pkwy
Suite A-B
Temple Terrace, FL 33617
Grant Number
1 NH25PS005131-01-00
Participating Start Date
1/1/2020
Last Recertification Date
5/27/2024
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
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