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OPTUM PHARMACY 702, LLC
CH010600 FENWAY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
FENWAY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Fenway Health, Ansin Building
Type
HRSA-Funded Health Center
340B ID
CH010600
Entity Address
1340 Boylston St
Boston, MA 02215
Grant Number
H80CS00303
Participating Start Date
1/1/2004
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/9/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Luis Rivera, Chief Financial Officer
(857) 347-4928
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/9/2021
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