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OPTUM PHARMACY 702, LLC
FQHCLA347 FAMILIES TOGETHER OF ORANGE COUNTY
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Covered Entity Details
Entity Name
FAMILIES TOGETHER OF ORANGE COUNTY
Subdivision Name
Families Together of Orange County
Type
Health Center Program Look-Alike
340B ID
FQHCLA347
Entity Address
661 W. 1st St., Ste. G
Tustin, CA 92780
Grant Number
LALCS00186
Participating Start Date
4/1/2017
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alexander Rossel, CEO
(714) 665-9890
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2020
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