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OPTUM PHARMACY 702, LLC
CH101630 VALLEY FAMILY HEALTH CARE INC
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Covered Entity Details
Entity Name
VALLEY FAMILY HEALTH CARE INC
Subdivision Name
VALLEY FAMILY HEALTH CARE - Payette Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH101630
Entity Address
1441 NE 10th Ave
Payette, ID 83661-5420
Grant Number
H80CS00556
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Heinze, CEO
(208) 642-7364
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/14/2021
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