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OPTUM PHARMACY 702, LLC
FQHCLA358 Equitas Health, Inc.
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Covered Entity Details
Entity Name
Equitas Health, Inc.
Subdivision Name
Equitas Health Short North
Type
Health Center Program Look-Alike
340B ID
FQHCLA358
Entity Address
1033 N High St
Columbus, OH 43201
Grant Number
LALCS31539
Participating Start Date
1/1/2018
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
1/15/2021
Contract Begin Date
1/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nick Saltman, Interim Chief Pharmacy Officer
(614) 987-5621
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2021
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