Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
CHC09959-00 GRACE COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

GRACE COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Grace Community Health Center, Inc

Type

HRSA-Funded Health Center

340B ID

CHC09959-00

Entity Address

39 Cumberland Gap Plaza
Gray, KY 40734

Grant Number

H80CS09959

Participating Start Date

10/1/2010

Last Recertification Date

2/1/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

10/14/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michael W Stanley, Chief Executive Officer
(606) 526-9005

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

10/14/2020

340B Drug Pricing Program Database